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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Patient flow to carotid endarterectomy: hastening the patient journey
Manar Khashram1, Justin A Roake, David R Lewis
1University of Otago, Christchurch School of Medicine, Christchurch, New Zealand.
Insights
Early carotid endarterectomy (CEA) is crucial for stroke prevention. A clinical audit found CEA times significantly reduced, but urgent referrals need improvement.
Area of Science:
- Vascular Surgery
- Neurology
- Clinical Audit
Background:
- Carotid endarterectomy (CEA) is standard for preventing recurrent stroke after TIA or stroke.
- This study audited CEA timeliness in a tertiary vascular unit.
Purpose of the Study:
- To assess if the standard of early CEA is met.
- To identify delays in the patient pathway for CEA.
Main Methods:
- Clinical audit of CEAs performed between 2006-2008.
- Mapping the patient journey from presentation to surgery in two phases.
- Exclusion of asymptomatic carotid lesion interventions.
Main Results:
- 81 patient journeys analyzed (55 phase 1, 26 phase 2).
- Median time from presentation to CEA significantly reduced from 83 to 32 days.
- Reduced delay between vascular surgery review and CEA observed.
Conclusions:
- Significant decrease in time from presentation to CEA achieved.
- Delay between vascular surgery review and CEA improved.
- Urgency of referral for imaging/surgical review requires improvement.
Background:
Early carotid endarterectomy (CEA) after stroke or transient ischaemic attack is the proposed standard of care to prevent recurrent ischaemic events in selected patients. The aim of this study was to investigate if this standard is achieved in a tertiary vascular unit.
Methods:
This was a clinical audit. CEAs performed from 1 January 2006 to 31 December 2008 at Christchurch hospital were identified. The value stream from initial presentation to surgery was mapped in two phases (phase 1; 2006-2007 and phase 2; 2008). Patients who had carotid intervention for asymptomatic carotid lesions were excluded.
Results:
The relevant patient journey was documented in 81 patients (55 phase 1; 26 phase 2). Median time from initial presentation to carotid ultrasound was 5 days in phase 1 and 6 days in phase 2. Time from presentation to vascular surgery review was 22 days in phase 1 and 13 days in phase 2. Time from presentation to CEA significantly reduced from 83 to 32 days between phases (P < 0.005).
Conclusions:
There has been a significant decrease in time from presentation to operation between phase 1 and 2. The most significant change is reduced delay between vascular surgery review and CEA. There has been no improvement in urgency of referral for imaging or surgical review. This part of the patient journey is a target for improvement.
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