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Botelho A, Rios J, Fidalgo AP, Ferreira E, Nzwalo H. Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316357. [PMID: 36498429 PMCID: PMC9735885 DOI: 10.3390/ijerph192316357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. METHODOLOGY Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. RESULTS A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. CONCLUSIONS Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.
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Affiliation(s)
- Ana Botelho
- Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Jonathan Rios
- Department of Physical Medicine and Rehabilitation, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Ana Paula Fidalgo
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
| | - Eugénia Ferreira
- Faculty of Economy, University of Algarve, 8005-139 Faro, Portugal
| | - Hipólito Nzwalo
- Stroke Unit, Algarve Hospital University Center-Faro, 8000-386 Faro, Portugal
- Faculty of Medicine and Biomedical Sciences, University of Algarve, 8005-139 Faro, Portugal
- Algarve Biomedical Research Institute, 8005-139 Faro, Portugal
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A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:487-494. [PMID: 34537162 DOI: 10.1016/j.nrleng.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/15/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Recent analyses emphasise that The Benchmark Stroke Door-to-Needle Time (DNT) should be 30min. This study aimed to determine if a new in-hospital IVT protocol is effective in reducing door-to-needle time and correcting previously identified factors associated with delays. MATERIAL AND METHODS In 2014, we gradually introduced a series of measures aimed to reduce door-to-needle time for patients receiving IVT, and compared it before (2009-2012) and after (2014-2017) the new protocol was introduced. RESULTS The sample included 239 patients before and 222 after the introduction of the protocol. Median overall door-to-needle time was 27min after the protocol was fully implemented (a 48% reduction on previous door-to-needle time [52min], P<.001)]. Median door-to-needle time was lower when pre-hospital code stroke was activated (22min). We observed a 26-min reduction in the median time from onset to treatment (P<.001). After the protocol was implemented, the "3-hour-effect" did not affect door-to-needle time (P=.98). Computed tomography angiography studies performed before IVT were associated with increased door-to-needle time (P<.001); however, the test was performed after IVT was started in most cases. CONCLUSIONS Hospital reorganisation and multidisciplinary collaboration brought median door-to-needle time below 30min and corrected previously identified delay factors. Furthermore, overall time from onset to treatment was also reduced and more stroke patients were treated within 90min of symptom onset.
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Iglesias Mohedano A, García Pastor A, Díaz Otero F, Vázquez Alen P, Martín Gómez M, Simón Campo P, Salgado Cámara P, Esteban de Antonio E, Lázaro García E, Funes Molina C, del Valle Diéguez M, Saura Lorente J, Fernández Bullido Y, Gil Nuñez A. Un nuevo protocolo intrahospitalario reduce el tiempo puerta-aguja en el ictus agudo tratado con trombolisis intravenosa a menos de 30 minutos. Neurologia 2021. [DOI: 10.1016/j.nrl.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Vicente-Pascual M, Quilez A, Gil MP, González-Mingot C, Vázquez-Justes D, Mauri-Capdevila G, Sanahuja J, García-Vázquez C, Purroy F. The influence of organisational management on door-to-needle times for fibrinolytic treatment. Neurologia 2020; 38:S0213-4853(20)30428-X. [PMID: 33358060 DOI: 10.1016/j.nrl.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Door-to-needle time (DNT) has been established as the main indicator in code stroke protocols. According to the 2018 guidelines of the American Heart Association/American Stroke Association, DNT should be less than 45minutes; therefore, effective and revised pre-admission and in-hospital protocols are required. METHOD We analysed organisational changes made between 2011 and 2019 and their influence on DNT and the clinical progression of patients treated with fibrinolysis. We collected data from our centre, stored and monitored under the Master Plan for Cerebrovascular Disease of the regional government of Catalonia. Among other measures, we analysed the differences between years and differences derived from the implementation of the Helsinki model. RESULTS The study included 447 patients, and we observed significant differences in DNT between different years. Pre-hospital code stroke activation, recorded in 315 cases (70.5%), reduced DNT by a median of 14minutes. However, the linear regression model only showed an inversely proportional relationship between the adoption of the Helsinki code stroke model and DNT (beta coefficient, -0.42; P<.001). The removal of vascular neurologists after the adoption of the Helsinki model increased DNT and the 90-day mortality rate. CONCLUSION DNT is influenced by the organisational model. In our sample, the application of the Helsinki model, the role of the lead vascular neurologist, and notification of code stroke by pre-hospital emergency services are key factors for the reduction of DNT and the clinical improvement of the patient.
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Affiliation(s)
- M Vicente-Pascual
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - A Quilez
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M P Gil
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - C González-Mingot
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - D Vázquez-Justes
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - G Mauri-Capdevila
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - J Sanahuja
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - C García-Vázquez
- Grupo de Neurociencias Clínicas, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, España
| | - F Purroy
- Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España; Grupo de Neurociencias Clínicas, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, España.
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Reducing Door-to-Needle Time for Tissue Plasminogen Activator Administration in a Community Hospital: An Operations Study. Qual Manag Health Care 2020; 29:188-193. [PMID: 32991535 DOI: 10.1097/qmh.0000000000000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The benefit of tissue plasminogen activator (tPA) in acute ischemic stroke is time dependent. A 15-minute decrease in door-to-needle (DTN) time has been associated with increased odds of ambulating independently, faster discharge, and decreased odds of death. We investigated common causes of delay in DTN times in a community hospital setting in order to identify areas for improvement. METHODS A retrospective medical record review was conducted at a 574-bed community hospital. This included 100 patients who received tPA from 2016 to 2019. Time segments were classified a priori to reflect key work elements from the time between hospital arrival to tPA and recorded for each chart. Linear regression models were used to identify work elements associated with increased DTN time. RESULTS Median DTN time was 54:29 minutes. Linear regression analyses determined that differences in NIHSS score (P = .030), triage to computed tomography (CT) start (P = .017), triage to stroke physician page (P = .016), and CT report to tPA administration (P < .001) were associated with increased DTN time. CT report to tPA administration was most strongly associated with a Pearson coefficient of 0.868 (P < .001) with increased DTN time. CONCLUSIONS The DTN time at our institution was above the recommended target. Our findings suggest that reducing the CT report time interval may decrease DTN time.
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Andreozzi F, Candido R, Corrao S, Fornengo R, Giancaterini A, Ponzani P, Ponziani MC, Tuccinardi F, Mannino D. Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review. Diabetol Metab Syndr 2020; 12:52. [PMID: 32565924 PMCID: PMC7301473 DOI: 10.1186/s13098-020-00559-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care.
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Affiliation(s)
- F. Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - R. Candido
- Diabetes Center District 3, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - S. Corrao
- Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - R. Fornengo
- SSD of Diabetology and Metabolic Diseases, Hospital of Chivasso, Turin, Italy
| | | | - P. Ponzani
- Operative Unit of Diabetology, “La Colletta” Hospital, Genoa, Italy
| | - M. C. Ponziani
- SSD of Diabetology-Azienda Sanitaria Locale Novara, Novara, Italy
| | - F. Tuccinardi
- Diabetology and Endocrinology Unit “Clinica del Sole” Formia, Formia, Italy
| | - D. Mannino
- Section of Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
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Tanaka K, Matsumoto S, Yamada T, Nagano S, Takase KI, Hatano T, Yamasaki R, Kira JI. Temporal Trends in Clinical Characteristics and Door-to-Needle Time in Patients Receiving Intravenous Tissue Plasminogen Activator: A Retrospective Study of 4 Hospitals in Japan. J Stroke Cerebrovasc Dis 2019; 28:104305. [PMID: 31405791 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/03/2019] [Accepted: 07/21/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Intravenous recombinant tissue plasminogen activator (rt-PA) has become a common treatment for acute ischemic stroke and has highly time-dependent benefits. We aimed to clarify temporal trends regarding the frequency and characteristics of patients receiving rt-PA and explore factors associated with door-to-needle time (DNT) in Japanese emergency hospitals. METHODS Consecutive patients who received intravenous rt-PA for acute ischemic stroke from October 2005 to December 2015 were retrospectively registered from 4 hospitals. Temporal trends in the frequency and characteristics of patients receiving rt-PA and factors associated with DNT were investigated. RESULTS A total of 750 patients, including 688 (420 men, median 75 years old) with out-of-hospital stroke, were registered. The frequency of patients receiving intravenous rt-PA for acute ischemic stroke continuously increased from 1.8% in 2005 to 9.5% in 2015. The proportion of patients who were elderly or had prestroke disability increased over time, while pretreatment stroke severity declined. The DNT gradually decreased (median 105 minutes in 2005, 61 minutes in 2015). According to multivariate regression analysis with correction for multiple comparisons, activation of a code stroke system (standardized partial regression coefficient (β) -.50, P < .001, q < .001), onset-to-door time (β -.15, P < .001, q < .001), pretreatment with antithrombotic agents (β .12, P < .001, q = .001), and year of treatment (β .11, P = .007, q = .011) were associated with DNT. CONCLUSIONS Intravenous rt-PA was widely adopted in Japanese emergency hospitals. Characteristics of patients receiving intravenous rt-PA have changed over the past decade. Several factors, including the year of treatment, were associated with DNT, which has shortened over time.
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Affiliation(s)
- Koji Tanaka
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shoji Matsumoto
- Departments of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan; Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takeshi Yamada
- Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Sukehisa Nagano
- Department of Neurology, Fukuoka City Hospital, Fukuoka, Japan
| | | | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Olascoaga Arrate A, Freijo Guerrero M, Fernández Maiztegi C, Azkune Calle I, Silvariño Fernández R, Fernández Rodríguez M, Vazquez Naveira P, Anievas Elena A, Iturraspe González I, Pérez Díez Y, Ruiz Fernández R. Use of emergency medical transport and impact on time to care in patients with ischaemic stroke. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Iglesias Mohedano AM, García Pastor A, Díaz Otero F, Vázquez Alen P, Vales Montero M, Luque Buzo E, Redondo Ráfales N, Chavarria Cano B, Fernández Bullido Y, Villanueva Osorio JA, Gil Núñez A. Efficacy of New Measures Saving Time in Acute Stroke Management: A Quantified Analysis. J Stroke Cerebrovasc Dis 2017; 26:1817-1823. [PMID: 28522232 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times. METHODS Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014. A series of measures aimed at reducing in-hospital delays were implemented. We compared DTI, ITN, and DTN times between patients who underwent the interventions and those who did not. RESULTS 231 patients. DTI time was lower when personal history was reviewed and tests were ordered before patient arrival (2.5 minutes saved, P = .016) and when electrocardiogram was not made (5.4 minutes saved, P < .001). Not performing a computed tomography angiography and not waiting for coagulation results from laboratory before intravenous thrombolysis (25.5%) reduced ITN time significantly (14 and 12 minutes saved, respectively, P < .001). These interventions remained as independent predictors of a shorter ITN and DTN time. Completing all steps resulted in the lowest DTI and ITN times (13 and 19 minutes, respectively). CONCLUSIONS Every measure is an important part of a chain focused on saving time in acute stroke: the lowest DTI and ITN times were obtained when all steps were completed. Measures shortening ITN time produced a greater impact on DTN time reduction; therefore, ITN interventions should be considered a critical part of new protocols and guidelines.
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Affiliation(s)
- Ana María Iglesias Mohedano
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Andrés García Pastor
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Díaz Otero
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Vázquez Alen
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Vales Montero
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elisa Luque Buzo
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nuria Redondo Ráfales
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Beatriz Chavarria Cano
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Yolanda Fernández Bullido
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Antonio Gil Núñez
- Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Olascoaga Arrate A, Freijo Guerrero MM, Fernández Maiztegi C, Azkune Calle I, Silvariño Fernández R, Fernández Rodríguez M, Vazquez Naveira P, Anievas Elena A, Iturraspe González I, Pérez Díez Y, Ruiz Fernández R. Use of emergency medical transport and impact on time to care in patients with ischaemic stroke. Neurologia 2017; 34:80-88. [PMID: 28094089 DOI: 10.1016/j.nrl.2016.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/07/2016] [Accepted: 11/12/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays. OBJECTIVES To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care. METHODS We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively. Data were obtained from the patients' medical histories and interviews with the patients themselves or their companions. We studied the following variables: previous health status, stroke symptoms and severity (NIHSS), type of transport, and time to medical care. Univariate and multivariate analyses were performed to identify factors associated with use of EMS and care delays. RESULTS Patients transported to hospital by the EMS accounted for 47.2% of the total. Greater stroke severity, arriving at the hospital at night, and poor functional status at baseline were found to be independently associated with use of EMS. Use of EMS was linked to earlier arrival at the hospital. Door-to-imaging times were shorter in the EMS group; however, this association disappeared after adjusting for stroke severity. Revascularisation was more frequent among patients transported by the EMS. CONCLUSIONS EMS transport was associated with shorter prehospital delays. Effective health education programmes should be developed to promote EMS transport for patients with stroke symptoms. In-hospital stroke management should also be improved to reduce time to medical care.
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Affiliation(s)
- A Olascoaga Arrate
- Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España.
| | - M M Freijo Guerrero
- Servicio de Neurología, Hospital Universitario Basurto, Osakidetza, Bilbao, Bizkaia, España
| | - C Fernández Maiztegi
- Servicio de Neurología, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, España
| | - I Azkune Calle
- Servicio de Neurología, Hospital Galdakao-Usansolo, Osakidetza, Galdakao, Bizkaia, España
| | - R Silvariño Fernández
- Servicio de Medicina Interna, Servicio de Urgencias, Hospital San Eloy, Osakidetza, Barakaldo, Bizkaia, España
| | - M Fernández Rodríguez
- Servicio de Medicina Interna, Servicio de Urgencias, Hospital San Eloy, Osakidetza, Barakaldo, Bizkaia, España
| | - P Vazquez Naveira
- Emergencias de Osakidetza, Servicio Vasco de Salud, Bilbao, Bizkaia, España
| | - A Anievas Elena
- Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España
| | - I Iturraspe González
- Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España
| | - Y Pérez Díez
- Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España
| | - R Ruiz Fernández
- Delegación Territorial de Bizkaia, Departamento de Salud del Gobierno Vasco, Bilbao, Bizkaia, España
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Bowen M, Prater A, Safdar NM, Dehkharghani S, Fountain JA. Utilization of Workflow Process Maps to Analyze Gaps in Critical Event Notification at a Large, Urban Hospital. J Digit Imaging 2016; 29:420-4. [PMID: 26667658 PMCID: PMC4942383 DOI: 10.1007/s10278-015-9838-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Stroke care is a time-sensitive workflow involving multiple specialties acting in unison, often relying on one-way paging systems to alert care providers. The goal of this study was to map and quantitatively evaluate such a system and address communication gaps with system improvements. A workflow process map of the stroke notification system at a large, urban hospital was created via observation and interviews with hospital staff. We recorded pager communication regarding 45 patients in the emergency department (ED), neuroradiology reading room (NRR), and a clinician residence (CR), categorizing transmissions as successful or unsuccessful (dropped or unintelligible). Data analysis and consultation with information technology staff and the vendor informed a quality intervention-replacing one paging antenna and adding another. Data from a 1-month post-intervention period was collected. Error rates before and after were compared using a chi-squared test. Seventy-five pages regarding 45 patients were recorded pre-intervention; 88 pages regarding 86 patients were recorded post-intervention. Initial transmission error rates in the ED, NRR, and CR were 40.0, 22.7, and 12.0 %. Post-intervention, error rates were 5.1, 18.8, and 1.1 %, a statistically significant improvement in the ED (p < 0.0001) and CR (p = 0.004) but not NRR (p = 0.208). This intervention resulted in measureable improvement in pager communication to the ED and CR. While results in the NRR were not significant, this intervention bolsters the utility of workflow process maps. The workflow process map effectively defined communication failure parameters, allowing for systematic testing and intervention to improve communication in essential clinical locations.
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Affiliation(s)
- Meredith Bowen
- Emory University School of Medicine, Atlanta, GA, 30307, USA.
| | - Adam Prater
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, Room D125A, Atlanta, GA, 30322, USA
| | - Nabile M Safdar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, Room D125A, Atlanta, GA, 30322, USA
| | - Seena Dehkharghani
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, Room D125A, Atlanta, GA, 30322, USA
- Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital and Emory University Hospital, Atlanta, GA, USA
| | - Jack A Fountain
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd. NE, Room D125A, Atlanta, GA, 30322, USA
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