Reducing door-to-puncture times for intra-arterial stroke therapy: a pilot quality improvement project.
J Am Heart Assoc
; 3(6): e000963, 2014 Nov 11.
Article
em En
| MEDLINE
| ID: mdl-25389281
ABSTRACT
BACKGROUND:
Delays to intra-arterial therapy (IAT) lead to worse outcomes in stroke patients with proximal occlusions. Little is known regarding the magnitude of, and reasons for, these delays. In a pilot quality improvement (QI) project, we sought to examine and improve our door-puncture times. METHODS ANDRESULTS:
For anterior-circulation stroke patients who underwent IAT, we retrospectively calculated in-hospital time delays associated with various phases from patient arrival to groin puncture. We formulated and then implemented a process change targeted to the phase with the greatest delay. We examined the impact on time to treatment by comparing the pre- and post-QI cohorts. One hundred forty-six patients (93 pre- vs. 51 post-QI) were analyzed. In the pre-QI cohort (ie, sequential process), the greatest delay occurred from imaging to the neurointerventional (NI) suite ("picture-suite" median, 62 minutes; interquartile range [IQR], 40 to 82). A QI measure was instituted so that the NI team and anesthesiologist were assembled and the suite set up in parallel with completion of imaging and decision making. The post-QI (ie, parallel process) median picture-to-suite time was 29 minutes (IQR, 21 to 41; P<0.0001). There was a 36-minute reduction in median door-to-puncture time (143 vs. 107 minutes; P<0.0001). Parallel workflow and presentation during work hours were independent predictors of shorter door-puncture times.CONCLUSIONS:
In-hospital delays are a major obstacle to timely IAT. A simple approach for achieving substantial time savings is to mobilize the NI and anesthesia teams during patient evaluation and treatment decision making. This parallel workflow resulted in a >30-minute (25%) reduction in median door-to-puncture times.Palavras-chave
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Assunto principal:
Terapia Trombolítica
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Avaliação de Processos em Cuidados de Saúde
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Trombectomia
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Indicadores de Qualidade em Assistência à Saúde
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Acidente Vascular Cerebral
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Melhoria de Qualidade
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Fibrinolíticos
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Tempo para o Tratamento
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article