Fast-Track Systems Improve Timely Carotid Endarterectomy in Stroke Prevention Outpatients

Area of Science:

• Neurology
• Vascular Surgery
• Healthcare Systems

Background:

• Optimal stroke prevention guidelines recommend carotid endarterectomy (CEA) within two weeks for symptomatic patients.
• A 2013 Ontario study revealed only 9% of eligible patients from Stroke Prevention Clinics (SPCs) met this target.
• Urgent CEA timeliness and quality improvement requires identifying modifiable system factors.

Purpose of the Study:

• To identify modifiable system factors influencing the quality and timeliness of urgent carotid endarterectomy (CEA).
• To analyze patient characteristics and timelines from symptom onset to CEA.
• To determine factors contributing to delays or improvements in CEA care pathways.

Main Methods:

• Retrospective chart review of transient ischemic attack/stroke patients undergoing CEA between 2011-2014.
• Analysis of patients assessed in Champlain Local Health Integrated Network SPCs.
• Descriptive and multivariate statistical analyses of patient data, timelines, and system factors.

Main Results:

• Median time from symptom onset to CEA was 31 days; only 21.3% received surgery within two weeks.
• Significant delays occurred in patient presentation, assessment, vascular imaging, and surgical scheduling.
• Rapid testing, triage, and inter-team collaboration (SPC, surgical, radiology) improved timelines.

Conclusions:

• Multifaceted system changes are crucial for rapid CEA, including public stroke awareness and 911 utilization.
• Improved access to vascular imaging and redesigned clinical services promoting collaboration are key.
• Implementing performance measures to monitor and guide clinical innovations is recommended for better outcomes.