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A System-Based Intervention to Improve Access to Hyperacute Stroke Care.

Richard H Swartz1, Elizabeth Linkewich1, Shelley Sharp2

  • 11North and East Greater Toronto Area Stroke Network,Sunnybrook Health Sciences Centre,University of Toronto,Toronto,Ontario,Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|May 10, 2017
PubMed
Summary
This summary is machine-generated.

New protocols improved hyperacute stroke care by enabling faster transfers of "walk-in" patients from non-stroke centers to regional stroke centers, increasing treatment rates and reducing transport times.

Keywords:
Strokeacute strokestroke carethrombolysis (tPA)

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Healthcare Systems Engineering

Background:

  • Hyperacute stroke requires rapid treatment for optimal patient outcomes.
  • Patients not arriving via emergency medical services (EMS) may not reach specialized stroke centers promptly.
  • Protocols were needed to identify and transfer

Purpose of the Study:

  • To develop and evaluate protocols for identifying and transferring "walk-in" stroke patients from non-hyperacute hospitals to regional stroke centers (RSCs).
  • To improve patient flow and access to timely hyperacute stroke interventions.

Main Methods:

  • A multi-disciplinary, multi-institutional working group developed consensus-based protocols.
  • Protocols were implemented across 14 acute hospital sites.
  • Key metrics were tracked 18 months pre- and post-implementation, including patient transports, tissue plasminogen activator (tPA) administration, and EMS response/transport times.

Main Results:

  • Patient transports to RSCs increased by 80% (103 to 185).
  • The number of patients receiving tPA increased by 68% (34 to 57).
  • Mean EMS transport time decreased by 17 minutes (54.46 to 37.86 minutes, p<0.0001), and calls responded to within 9 minutes increased from 34% to 59%.

Conclusions:

  • A systems-based approach with multi-organizational collaboration and consensus protocols effectively improved hyperacute stroke care.
  • The implemented protocols led to increased delivery of stroke interventions and enhanced EMS response and transport efficiency.
  • These protocols offer a model for other regions to optimize patient flow within stroke care systems, especially with increasing centralization and endovascular therapy.