Thrombolysis in acute ischemic stroke: a simulation study to improve pre- and in-hospital delays in community hospitals
Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how to improve thrombolysis rate in decentralized care. The aim of this simulation study was to as...
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| Veröffentlicht in: | PloS one 2013-11, Vol.8 (11), p.e79049-e79049 |
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| description | Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how to improve thrombolysis rate in decentralized care. The aim of this simulation study was to assess the impact of previously identified success factors in a central model on thrombolysis rates and patient outcome when implemented for a decentral model.
Based on a prospectively collected dataset of 1084 ischemic stroke patients, simulation was used to replicate current practice and estimate the effect of re-organizing decentralized stroke care to resemble a centralized model. Factors simulated included symptom onset call to help, emergency medical services transportation, and in-hospital diagnostic workup delays. Primary outcome was proportion of patients treated with thrombolysis; secondary endpoints were good functional outcome at 90 days, Onset-Treatment-Time (OTT), and OTT intervals, respectively.
Combining all factors might increase thrombolysis rate by 7.9%, of which 6.6% ascribed to pre-hospital and 1.3% to in-hospital factors. Good functional outcome increased by 11.4%, 8.7% ascribed to pre-hospital and 2.7% to in-hospital factors. The OTT decreased 17 minutes, 7 minutes ascribed to pre-hospital and 10 minutes to in-hospital factors. An increase was observed in the proportion thrombolyzed within 1.5 hours; increasing by 14.1%, of which 5.6% ascribed to pre-hospital and 8.5% to in-hospital factors.
Simulation technique may target opportunities for improving thrombolysis rates in acute stroke. Pre-hospital factors proved to be the most promising for improving thrombolysis rates in an implementation study. |
| doi_str_mv | 10.1371/journal.pone.0079049 |
| format | Article |
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Based on a prospectively collected dataset of 1084 ischemic stroke patients, simulation was used to replicate current practice and estimate the effect of re-organizing decentralized stroke care to resemble a centralized model. Factors simulated included symptom onset call to help, emergency medical services transportation, and in-hospital diagnostic workup delays. Primary outcome was proportion of patients treated with thrombolysis; secondary endpoints were good functional outcome at 90 days, Onset-Treatment-Time (OTT), and OTT intervals, respectively.
Combining all factors might increase thrombolysis rate by 7.9%, of which 6.6% ascribed to pre-hospital and 1.3% to in-hospital factors. Good functional outcome increased by 11.4%, 8.7% ascribed to pre-hospital and 2.7% to in-hospital factors. The OTT decreased 17 minutes, 7 minutes ascribed to pre-hospital and 10 minutes to in-hospital factors. An increase was observed in the proportion thrombolyzed within 1.5 hours; increasing by 14.1%, of which 5.6% ascribed to pre-hospital and 8.5% to in-hospital factors.
Simulation technique may target opportunities for improving thrombolysis rates in acute stroke. Pre-hospital factors proved to be the most promising for improving thrombolysis rates in an implementation study.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0079049</identifier><identifier>PMID: 24260151</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute Disease ; Brain Ischemia - pathology ; Brain Ischemia - physiopathology ; Brain Ischemia - therapy ; Communities ; Comparative analysis ; Computer simulation ; Consent ; Diagnostic systems ; Emergency medical services ; Emergency vehicles ; Female ; Health services ; Hospitals ; Hospitals, Community ; Humans ; Ischemia ; Male ; Medical research ; Models, Biological ; Neurology ; Patients ; Simulation ; Stroke ; Stroke - pathology ; Stroke - physiopathology ; Stroke - therapy ; Success factors ; Thrombolysis ; Thrombolytic Therapy ; Time Factors</subject><ispartof>PloS one, 2013-11, Vol.8 (11), p.e79049-e79049</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Lahr et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/3.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Lahr et al 2013 Lahr et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-4b4101ff555f5117eeb57d9ffead73d702019d562238ca2c58395c30514adaa93</citedby><cites>FETCH-LOGICAL-c692t-4b4101ff555f5117eeb57d9ffead73d702019d562238ca2c58395c30514adaa93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832502/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832502/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24260151$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Meuth, Sven G.</contributor><creatorcontrib>Lahr, Maarten M H</creatorcontrib><creatorcontrib>van der Zee, Durk-Jouke</creatorcontrib><creatorcontrib>Vroomen, Patrick C A J</creatorcontrib><creatorcontrib>Luijckx, Gert-Jan</creatorcontrib><creatorcontrib>Buskens, Erik</creatorcontrib><title>Thrombolysis in acute ischemic stroke: a simulation study to improve pre- and in-hospital delays in community hospitals</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how to improve thrombolysis rate in decentralized care. The aim of this simulation study was to assess the impact of previously identified success factors in a central model on thrombolysis rates and patient outcome when implemented for a decentral model.
Based on a prospectively collected dataset of 1084 ischemic stroke patients, simulation was used to replicate current practice and estimate the effect of re-organizing decentralized stroke care to resemble a centralized model. Factors simulated included symptom onset call to help, emergency medical services transportation, and in-hospital diagnostic workup delays. Primary outcome was proportion of patients treated with thrombolysis; secondary endpoints were good functional outcome at 90 days, Onset-Treatment-Time (OTT), and OTT intervals, respectively.
Combining all factors might increase thrombolysis rate by 7.9%, of which 6.6% ascribed to pre-hospital and 1.3% to in-hospital factors. Good functional outcome increased by 11.4%, 8.7% ascribed to pre-hospital and 2.7% to in-hospital factors. The OTT decreased 17 minutes, 7 minutes ascribed to pre-hospital and 10 minutes to in-hospital factors. An increase was observed in the proportion thrombolyzed within 1.5 hours; increasing by 14.1%, of which 5.6% ascribed to pre-hospital and 8.5% to in-hospital factors.
Simulation technique may target opportunities for improving thrombolysis rates in acute stroke. 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lahr, Maarten M H</au><au>van der Zee, Durk-Jouke</au><au>Vroomen, Patrick C A J</au><au>Luijckx, Gert-Jan</au><au>Buskens, Erik</au><au>Meuth, Sven G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thrombolysis in acute ischemic stroke: a simulation study to improve pre- and in-hospital delays in community hospitals</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-11-18</date><risdate>2013</risdate><volume>8</volume><issue>11</issue><spage>e79049</spage><epage>e79049</epage><pages>e79049-e79049</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how to improve thrombolysis rate in decentralized care. The aim of this simulation study was to assess the impact of previously identified success factors in a central model on thrombolysis rates and patient outcome when implemented for a decentral model.
Based on a prospectively collected dataset of 1084 ischemic stroke patients, simulation was used to replicate current practice and estimate the effect of re-organizing decentralized stroke care to resemble a centralized model. Factors simulated included symptom onset call to help, emergency medical services transportation, and in-hospital diagnostic workup delays. Primary outcome was proportion of patients treated with thrombolysis; secondary endpoints were good functional outcome at 90 days, Onset-Treatment-Time (OTT), and OTT intervals, respectively.
Combining all factors might increase thrombolysis rate by 7.9%, of which 6.6% ascribed to pre-hospital and 1.3% to in-hospital factors. Good functional outcome increased by 11.4%, 8.7% ascribed to pre-hospital and 2.7% to in-hospital factors. The OTT decreased 17 minutes, 7 minutes ascribed to pre-hospital and 10 minutes to in-hospital factors. An increase was observed in the proportion thrombolyzed within 1.5 hours; increasing by 14.1%, of which 5.6% ascribed to pre-hospital and 8.5% to in-hospital factors.
Simulation technique may target opportunities for improving thrombolysis rates in acute stroke. Pre-hospital factors proved to be the most promising for improving thrombolysis rates in an implementation study.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>24260151</pmid><doi>10.1371/journal.pone.0079049</doi><tpages>e79049</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Brain Ischemia - pathology Brain Ischemia - physiopathology Brain Ischemia - therapy Communities Comparative analysis Computer simulation Consent Diagnostic systems Emergency medical services Emergency vehicles Female Health services Hospitals Hospitals, Community Humans Ischemia Male Medical research Models, Biological Neurology Patients Simulation Stroke Stroke - pathology Stroke - physiopathology Stroke - therapy Success factors Thrombolysis Thrombolytic Therapy Time Factors |
| title | Thrombolysis in acute ischemic stroke: a simulation study to improve pre- and in-hospital delays in community hospitals |
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