Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital.
J Stroke Cerebrovasc Dis
; 26(7): 1500-1505, 2017 Jul.
Article
en En
| MEDLINE
| ID: mdl-28396187
ABSTRACT
BACKGROUND AND PURPOSE:
Shorter time-to-thrombolysis in acute ischemic stroke (AIS) is associated with improved functional outcome and reduced morbidity. We evaluate the effect of several interventions to reduce time-to-thrombolysis at an urban, public safety net hospital.METHODS:
All patients treated with tissue plasminogen activator for AIS at our institution between 2008 and 2015 were included in a retrospective analysis of door-to-needle (DTN) time and associated factors. Between 2011 and 2014, we implemented 11 distinct interventions to reduce DTN time. Here, we assess the relative impact of each intervention on DTN time.RESULTS:
The median DTN time pre- and postintervention decreased from 87 (interquartile range 68-109) minutes to 49 (interquartile range 39-63) minutes. The reduction was comprised primarily of a decrease in median time from computed tomography scan order to interpretation. The goal DTN time of 60 minutes or less was achieved in 9% (95% confidence interval 5%-22%) of cases preintervention, compared with 70% (58%-81%) postintervention. Interventions with the greatest impact on DTN time included the implementation of a stroke group paging system, dedicated emergency department stroke pharmacists, and the development of a stroke code supply box.CONCLUSIONS:
Multidisciplinary, collaborative interventions are associated with a significant and substantial reduction in time-to-thrombolysis. Such targeted interventions are efficient and achievable in resource-limited settings, where they are most needed.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Terapia Trombolítica
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Isquemia Encefálica
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Activador de Tejido Plasminógeno
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Prestación Integrada de Atención de Salud
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Accidente Cerebrovascular
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Fibrinolíticos
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Tiempo de Tratamiento
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Proveedores de Redes de Seguridad
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Hospitales Públicos
Tipo de estudio:
Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2017
Tipo del documento:
Article