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Shortening door-to-puncture time and improving patient outcome with workflow optimization in patients with acute ischemic stroke associated with large vessel occlusion.
Yang, Shuiquan; Yao, Weiping; Siegler, James E; Mofatteh, Mohammad; Wellington, Jack; Wu, Jiale; Liang, Wenjun; Chen, Gan; Huang, Zhou; Yang, Rongshen; Chen, Juanmei; Yang, Yajie; Hu, Zhaohui; Chen, Yimin.
  • Yang S; Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, No. 16, Guanghaidadaoxi, Sanshui District, Foshan, 528100, Guangdong Province, China.
  • Yao W; Dean Office and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China.
  • Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA.
  • Mofatteh M; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
  • Wellington J; School of Medicine, Cardiff University, Wales, UK.
  • Wu J; Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China.
  • Liang W; School of Medicine, Shaoguan University, Shaoguan, Guangdong Province, China.
  • Chen G; Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, No. 16, Guanghaidadaoxi, Sanshui District, Foshan, 528100, Guangdong Province, China.
  • Huang Z; Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, No. 16, Guanghaidadaoxi, Sanshui District, Foshan, 528100, Guangdong Province, China.
  • Yang R; Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China.
  • Chen J; Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China.
  • Yang Y; School of Medicine, Shaoguan University, Shaoguan, Guangdong Province, China.
  • Hu Z; The Second Clinical College, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
  • Chen Y; The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China.
BMC Emerg Med ; 22(1): 136, 2022 07 26.
Article in English | MEDLINE | ID: covidwho-1962739
ABSTRACT

OBJECTIVE:

We aimed to evaluate door-to-puncture time (DPT) and door-to-recanalization time (DRT) without directing healthcare by neuro-interventionalist support in the emergency department (ED) by workflow optimization and improving patients' outcomes.

METHODS:

Records of 98 consecutive ischemic stroke patients who had undergone endovascular therapy (EVT) between 2018 to 2021 were retrospectively reviewed in a single-center study. Patients were divided into three groups pre-intervention (2018-2019), interim-intervention (2020), and post-intervention (January 1st 2021 to August 16th, 2021). We compared door-to-puncture time, door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), last known normal time to-puncture time (LKNPT), and patient outcomes (measured by 3 months modified Rankin Scale) between three groups using descriptive statistics.

RESULTS:

Our findings indicate that process optimization measures could shorten DPT, DRT, PRT, and LKNPT. Median LKNPT was shortened by 70 min from 325 to 255 min(P < 0.05), and DPT was shortened by 119 min from 237 to 118 min. DRT shortened by 132 min from 338 to 206 min, and PRT shortened by 33 min from 92 to 59 min from the pre-intervention to post-intervention groups (all P < 0.05). Only 21.4% of patients had a favorable outcome in the pre-intervention group as compared to 55.6% in the interventional group (P= 0.026).

CONCLUSION:

This study demonstrated that multidisciplinary cooperation was associated with shortened DPT, DRT, PRT, and LKNPT despite challenges posed to the healthcare system such as the COVID-19 pandemic. These practice paradigms may be transported to other stroke centers and healthcare providers to improve endovascular time metrics and patient outcomes.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Stroke / Ischemic Stroke / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: BMC Emerg Med Journal subject: Emergency Medicine Year: 2022 Document Type: Article Affiliation country: S12873-022-00692-8

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Stroke / Ischemic Stroke / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: BMC Emerg Med Journal subject: Emergency Medicine Year: 2022 Document Type: Article Affiliation country: S12873-022-00692-8