Effects of a Feedback-Demanding Stroke Clock on Acute Stroke Management: A Randomized Study

Area of Science:

• Neurology
• Emergency Medicine
• Health Services Research

Background:

• Acute stroke management requires rapid interventions to minimize patient disability.
• Delays in diagnosis and treatment can lead to poorer functional outcomes.
• Optimizing workflow in stroke care is crucial for improving patient survival and recovery.

Purpose of the Study:

• To evaluate the effectiveness of a "stroke clock" system in accelerating acute stroke management.
• To determine if active physician feedback via a timed alarm system improves treatment metrics.
• To assess the impact of a stroke clock on time-sensitive decision-making and interventions.

Main Methods:

• A randomized controlled trial was conducted with 107 participants.
• A specialized alarm clock was implemented in the CT scan room to prompt timely actions.
• Target times were set for neurological examination, CT scanning, lab work, and thrombolysis initiation, requiring physician feedback.
• Key time metrics and functional outcomes (modified Rankin Scale) were assessed.

Main Results:

• Stroke clock patients showed significantly faster times for treatment decision (16.7 vs. 26.0 min), neurological exam completion (7.3 vs. 10.0 min), CT scans (11.2 vs. 14.0 min), and thrombolysis needle time (18.8 vs. 47.0 min).
• Point-of-care lab testing was also significantly expedited (12.1 vs. 20.0 min).
• No significant differences were observed in door-to-groin puncture times or 90-day functional outcomes.

Conclusions:

• The stroke clock, demanding active physician feedback, significantly enhances acute stroke management metrics.
• This system represents a potentially low-cost strategy for optimizing time-sensitive stroke treatment protocols.
• Further implementation of such feedback systems could improve efficiency in emergency stroke care.