Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke
•Streamlined thrombectomy workflows dramatically improved door-to-puncture time.•Among transferred patients, CTA was increasingly performed before transfer.•Treatment was fast despite waiting for CTA confirmation of large vessel occlusion. Shorter time from symptom onset to treatment is associated w...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2018-03, Vol.166, p.71-75 |
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| creator | Kansagra, Akash P. Wallace, Adam N. Curfman, David R. McEachern, James D. Moran, Christopher J. Cross, DeWitte T. Lee, Jin-Moo Ford, Andria L. Manu, S. Goyal Panagos, Peter D. Derdeyn, Colin P. |
| description | •Streamlined thrombectomy workflows dramatically improved door-to-puncture time.•Among transferred patients, CTA was increasingly performed before transfer.•Treatment was fast despite waiting for CTA confirmation of large vessel occlusion.
Shorter time from symptom onset to treatment is associated with improved outcomes in patients who undergo mechanical thrombectomy for treatment of acute ischemic stroke due to emergent large vessel occlusion. In this work, we detail pre-thrombectomy process improvements in a multi-hospital network and report the effect on door-to-puncture time in patients undergoing mechanical thrombectomy.
A streamlined workflow was adopted to minimize door-to-puncture time. Key features of this workflow included rapid and concurrent clinical and radiological evaluation with point-of-care image interpretation, pre-transfer IV thrombolysis and CTA for transferred patients, immediate transport to the angiography suite potentially before neurointerventional radiology team arrival, and minimalist room setup. Door-to-puncture time was measured prospectively and analyzed retrospectively for 78 consecutive patients treated between January 2015 and December 2015. Statistical analysis was performed using the F-test on individual coefficients of a linear regression model.
From quarter 1 to quarter 4, the number of thrombectomies performed increased by 173% (11 patients to 30 patients, p = 0.002), and there was a significant increase in the proportion of transferred patients that underwent pre-transfer CTA (p = 0.04). During this interval, overall median door-to-puncture time decreased by 74% (147 min to 39 min, p |
| doi_str_mv | 10.1016/j.clineuro.2018.01.026 |
| format | Article |
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Shorter time from symptom onset to treatment is associated with improved outcomes in patients who undergo mechanical thrombectomy for treatment of acute ischemic stroke due to emergent large vessel occlusion. In this work, we detail pre-thrombectomy process improvements in a multi-hospital network and report the effect on door-to-puncture time in patients undergoing mechanical thrombectomy.
A streamlined workflow was adopted to minimize door-to-puncture time. Key features of this workflow included rapid and concurrent clinical and radiological evaluation with point-of-care image interpretation, pre-transfer IV thrombolysis and CTA for transferred patients, immediate transport to the angiography suite potentially before neurointerventional radiology team arrival, and minimalist room setup. Door-to-puncture time was measured prospectively and analyzed retrospectively for 78 consecutive patients treated between January 2015 and December 2015. Statistical analysis was performed using the F-test on individual coefficients of a linear regression model.
From quarter 1 to quarter 4, the number of thrombectomies performed increased by 173% (11 patients to 30 patients, p = 0.002), and there was a significant increase in the proportion of transferred patients that underwent pre-transfer CTA (p = 0.04). During this interval, overall median door-to-puncture time decreased by 74% (147 min to 39 min, p < 0.001); this decrease was greatest in transferred patients with pre-transfer CTA (81% decrease, 129 min to 25 min, p < 0.001) and smallest in patients presenting directly to the emergency department (52% decrease, 167 min to 87 min, p < 0.001).
Simple workflow improvements to streamline in-hospital triage and perform critical workup at transferring hospitals can produce reductions in door-to-puncture time.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2018.01.026</identifier><identifier>PMID: 29408777</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Angiography ; Cardiovascular system ; Ischemia ; Ischemic stroke ; Patients ; Process improvement ; Quality ; Stroke ; Thrombectomy ; Trends ; Workflow</subject><ispartof>Clinical neurology and neurosurgery, 2018-03, Vol.166, p.71-75</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Limited 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-bbdc293b158fa86beaaeb3c0bfe1cd0350fd786d046824c1207f820ebe2e974a3</citedby><cites>FETCH-LOGICAL-c462t-bbdc293b158fa86beaaeb3c0bfe1cd0350fd786d046824c1207f820ebe2e974a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2007508462?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29408777$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kansagra, Akash P.</creatorcontrib><creatorcontrib>Wallace, Adam N.</creatorcontrib><creatorcontrib>Curfman, David R.</creatorcontrib><creatorcontrib>McEachern, James D.</creatorcontrib><creatorcontrib>Moran, Christopher J.</creatorcontrib><creatorcontrib>Cross, DeWitte T.</creatorcontrib><creatorcontrib>Lee, Jin-Moo</creatorcontrib><creatorcontrib>Ford, Andria L.</creatorcontrib><creatorcontrib>Manu, S. Goyal</creatorcontrib><creatorcontrib>Panagos, Peter D.</creatorcontrib><creatorcontrib>Derdeyn, Colin P.</creatorcontrib><title>Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>•Streamlined thrombectomy workflows dramatically improved door-to-puncture time.•Among transferred patients, CTA was increasingly performed before transfer.•Treatment was fast despite waiting for CTA confirmation of large vessel occlusion.
Shorter time from symptom onset to treatment is associated with improved outcomes in patients who undergo mechanical thrombectomy for treatment of acute ischemic stroke due to emergent large vessel occlusion. In this work, we detail pre-thrombectomy process improvements in a multi-hospital network and report the effect on door-to-puncture time in patients undergoing mechanical thrombectomy.
A streamlined workflow was adopted to minimize door-to-puncture time. Key features of this workflow included rapid and concurrent clinical and radiological evaluation with point-of-care image interpretation, pre-transfer IV thrombolysis and CTA for transferred patients, immediate transport to the angiography suite potentially before neurointerventional radiology team arrival, and minimalist room setup. Door-to-puncture time was measured prospectively and analyzed retrospectively for 78 consecutive patients treated between January 2015 and December 2015. Statistical analysis was performed using the F-test on individual coefficients of a linear regression model.
From quarter 1 to quarter 4, the number of thrombectomies performed increased by 173% (11 patients to 30 patients, p = 0.002), and there was a significant increase in the proportion of transferred patients that underwent pre-transfer CTA (p = 0.04). During this interval, overall median door-to-puncture time decreased by 74% (147 min to 39 min, p < 0.001); this decrease was greatest in transferred patients with pre-transfer CTA (81% decrease, 129 min to 25 min, p < 0.001) and smallest in patients presenting directly to the emergency department (52% decrease, 167 min to 87 min, p < 0.001).
Simple workflow improvements to streamline in-hospital triage and perform critical workup at transferring hospitals can produce reductions in door-to-puncture time.</description><subject>Angiography</subject><subject>Cardiovascular system</subject><subject>Ischemia</subject><subject>Ischemic stroke</subject><subject>Patients</subject><subject>Process improvement</subject><subject>Quality</subject><subject>Stroke</subject><subject>Thrombectomy</subject><subject>Trends</subject><subject>Workflow</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1v1DAQhi0EokvhL1SWuHBJGDtZ27mBqvIhVeIAnC1_TKiXJF5sZ6Ve-O042pYDF04zh2femXlfQq4YtAyYeHto3RQWXFNsOTDVAmuBiydkx5TkjRiEekp20EHXqF7IC_Ii5wMAdJ1Qz8kFH3pQUsod-f21JDTzpuVpScH8QGqWrTVLHjHRY4olujhlGuban5D6GFNTYnNcF1fWhLSEGekYE8XFx5PJbp1MouUuxdmiK3G-p2Ghxq0FacjuDufgaC4p_sSX5NlopoyvHuol-f7h5tv1p-b2y8fP1-9vG9cLXhprveNDZ9lejUYJi8ag7RzYEZnz0O1h9FIJD71QvHeMgxwVB7TIcZC96S7Jm7NufeHXirnouV6C02QWjGvWbBgGNvSK8Yq-_gc9xDUt9TrNAeQeqqEbJc6USzHnhKM-pjCbdK8Z6C0hfdCPCektIQ1M14Tq4NWD_Gpn9H_HHiOpwLszgNWPU8Ckswu4OPQhVTe1j-F_O_4AtvmpQg</recordid><startdate>20180301</startdate><enddate>20180301</enddate><creator>Kansagra, Akash P.</creator><creator>Wallace, Adam N.</creator><creator>Curfman, David R.</creator><creator>McEachern, James D.</creator><creator>Moran, Christopher J.</creator><creator>Cross, DeWitte T.</creator><creator>Lee, Jin-Moo</creator><creator>Ford, Andria L.</creator><creator>Manu, S. 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Goyal</au><au>Panagos, Peter D.</au><au>Derdeyn, Colin P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2018-03-01</date><risdate>2018</risdate><volume>166</volume><spage>71</spage><epage>75</epage><pages>71-75</pages><issn>0303-8467</issn><eissn>1872-6968</eissn><abstract>•Streamlined thrombectomy workflows dramatically improved door-to-puncture time.•Among transferred patients, CTA was increasingly performed before transfer.•Treatment was fast despite waiting for CTA confirmation of large vessel occlusion.
Shorter time from symptom onset to treatment is associated with improved outcomes in patients who undergo mechanical thrombectomy for treatment of acute ischemic stroke due to emergent large vessel occlusion. In this work, we detail pre-thrombectomy process improvements in a multi-hospital network and report the effect on door-to-puncture time in patients undergoing mechanical thrombectomy.
A streamlined workflow was adopted to minimize door-to-puncture time. Key features of this workflow included rapid and concurrent clinical and radiological evaluation with point-of-care image interpretation, pre-transfer IV thrombolysis and CTA for transferred patients, immediate transport to the angiography suite potentially before neurointerventional radiology team arrival, and minimalist room setup. Door-to-puncture time was measured prospectively and analyzed retrospectively for 78 consecutive patients treated between January 2015 and December 2015. Statistical analysis was performed using the F-test on individual coefficients of a linear regression model.
From quarter 1 to quarter 4, the number of thrombectomies performed increased by 173% (11 patients to 30 patients, p = 0.002), and there was a significant increase in the proportion of transferred patients that underwent pre-transfer CTA (p = 0.04). During this interval, overall median door-to-puncture time decreased by 74% (147 min to 39 min, p < 0.001); this decrease was greatest in transferred patients with pre-transfer CTA (81% decrease, 129 min to 25 min, p < 0.001) and smallest in patients presenting directly to the emergency department (52% decrease, 167 min to 87 min, p < 0.001).
Simple workflow improvements to streamline in-hospital triage and perform critical workup at transferring hospitals can produce reductions in door-to-puncture time.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>29408777</pmid><doi>10.1016/j.clineuro.2018.01.026</doi><tpages>5</tpages></addata></record> |
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| subjects | Angiography Cardiovascular system Ischemia Ischemic stroke Patients Process improvement Quality Stroke Thrombectomy Trends Workflow |
| title | Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke |
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