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Published on: January 15, 2017
Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis
Sang-Beom Jeon1, Seung Mok Ryoo2, Deok Hee Lee3
1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Implementing a Stroke Alert Team (SAT) significantly reduced delays in acute stroke thrombolysis, improving patient outcomes. This multidisciplinary approach enhanced both intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT) times.
Area of Science:
- Emergency Medicine
- Neurology
- Clinical Quality Improvement
Background:
- Acute stroke treatment requires rapid thrombolysis (IVT and IAT) to minimize morbidity and mortality.
- In-hospital delays in administering thrombolysis remain a critical challenge.
- A 24/7 multidisciplinary approach is essential for optimizing acute stroke care.
Purpose of the Study:
- To decrease in-hospital delays for both intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT).
- To implement and evaluate a multidisciplinary Stroke Alert Team (SAT) for 24/7 acute stroke management.
- To improve thrombolysis rates and reduce post-thrombolysis complications.
Main Methods:
- Implementation of a Stroke Alert Team (SAT) involving hospital-initiated ambulance prenotification and reorganized in-hospital processes.
- Comparative analysis of patient characteristics, evaluation/thrombolysis times, thrombolysis rates, and post-thrombolysis intracranial hemorrhage before and after SAT implementation.
- Data collected from January 2014 to August 2016.
Main Results:
- Median door-to-CT, door-to-MRI, and door-to-laboratory times significantly decreased post-SAT.
- Median door-to-IVT time reduced from 46 to 20.5 minutes; median door-to-IAT time reduced from 156 to 86.5 minutes.
- Thrombolysis rate increased from 9.8% to 15.8%, while post-thrombolysis intracranial hemorrhage rate decreased from 12.6% to 2.1%.
Conclusions:
- The Stroke Alert Team (SAT) effectively decreased in-hospital delays for acute stroke thrombolysis.
- SAT implementation led to a significant increase in thrombolysis rates and a reduction in post-thrombolysis intracranial hemorrhage.
- The observed time benefits of SAT were consistent for both IVT and IAT, irrespective of time of day.
Background And Purpose:
Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day.
Methods:
We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016.
Results:
A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36-57 min) to 20.5 min (IQR 15.8-32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5-212.5 min) to 86.5 min (IQR 67.5-102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035).
Conclusions:
SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.
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