ASSESSING THE EFFECTIVENESS OF OPTIMIZATION STRATEGIES IN HOSPITAL CARE FOR STROKE CODE: IMPLICATIONS FOR DOOR-TO-NEEDLE TIMES
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Keywords
Cerebrovascular Accident, Ischemic Stroke, Acute Stroke, Door-To-Needle Time, Intravenous Fibrinolysis
Abstract
Introduction: Time plays a crucial role in the success of reperfusion treatments for acute ischemic stroke. Despite clinical guidelines recommending prompt intervention, only about one-third of patients receive fibrinolysis within ≤ 60 minutes. This study aims to outline our experience in implementing a specific protocol for acute ischemic stroke treatment and assess its impact on door-to-needle times.
Methods: Starting at the conclusion of 2015, a series of measures were gradually introduced to reduce response times and optimize care for acute ischemic stroke. This included the implementation of a dedicated neurovascular team. Performance times were compared before (2013-2015) and after (2017-2019) the introduction of the protocol.
Results: A total of 182 patients were included before and 249 after the implementation of the protocol. With the introduction of all measures, the overall median door-to-needle time reduced to 45 minutes (previously 74 minutes, a 39% reduction, p < 0.001). Notably, 73.5% of patients were treated within ≤ 60 minutes, representing a 47% increase compared to the pre-protocol period (p < 0.001). The overall time to treatment (symptom-to-needle onset) decreased by an average of 20 minutes (p < 0.001).
Conclusions: The measures incorporated into our protocol led to a significant and sustained reduction in door-to-needle times, though opportunities for further improvement persist. Established mechanisms for outcome monitoring and continuous enhancement will pave the way for ongoing progress in acute ischemic stroke care
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Sudhair Abbas Bangash
Faculty of Life Science, Department of Pharmacy, Sarhad University of Science and Information Technology, Peshawar, Pakistan
Naeem Ullah
Registrar, Department of Emergency Medicine, Mater Misericordiae University Hospital Dublin, Ireland
Dr. Abdul Wadood Kakar
Assistant Professor, HOD of Cardiology, Teaching Hospital Loralai, Bolan University of Medical and Health Sciences Quetta, Pakistan
Dr. Masooda Fatima
Assistant Professor, Department of Medicine, Baqai Medical University, Pakistan
Dr. Hira Amin
Post Graduate Trainee, Department of Medicine, Sindh Government Qatar Hospital, Graduated from Dow Medical College
Dr. Nikhilesh Jain
Director and Operational Head, Department of Critical Care Services, Care CHL Hospital Indore, India