Improvement of Door-to-Imaging Time in Acute Stroke Patients by Implementation of an All-Points Alarm

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• 作者：Christian H. Nolte ; MD ; PhD^&lowast ; ; ^&dagger ; ; ^{christian.nolte@charite.de} ; Uwe Malzahn ; PhD^&dagger ; ; York Kü ; hnle ; MD ; PhD^&Dagger ; ; Christoph J. Ploner ; MD ; Prof PhD^&lowast ; ; Jacqueline Mü ; ller-Nordhorn ; MD ; Prof PhD ; DPH^§ ; ; Martin Mö ; ckel ; MD ; Prof PhD^&Dagger ;
• 关键词：Emergency medicine ; stroke care delivery ; thrombolysis ; intrahospital delay ; educational campaign
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：22
• 期：2
• 页码：149-153
• 全文大小：154 K

文摘

In patients with acute ischemic stroke, thrombolysis offers an opportunity to effectively reduce disability and dependency. The success of this treatment is time-dependent. The crucial diagnostic step before initiation of treatment is cerebral imaging. With the aim of reducing in-hospital delays, our hospital¡¯s interdisciplinary stroke management group implemented an all-points alarm to improve in-hospital time delay (the period between arrival to the emergency department and performance of cerebral imaging). The alarm simultaneously alerted all involved staff (from the neurologist to in-hospital transport) to the arrival of a patient potentially eligible for thrombolysis. Time delay, sociodemographic, and clinical data were assessed prospectively at 4 months before and 8 months after alarm implementation. Data were examined by analysis of covariance for both the intention-to-treat and per-protocol groups. During the assessment, 689 patients with symptoms compatible with stroke arrived at our hospital. Among those, 111 patients (16 % ) were eligible for thrombolysis (median age, 71 years; median National Institutes of Health Stroke Scale score, 11; 44 % female). Patient characteristics (ie,?age, sex, insurance status, National Institutes of Health Stroke Scale score, cardiovascular risk factors, and prehospital delay) did not differ significantly before (n?=?34) and after (n = 77) alarm implementation. The median ¡°door-to-imaging time¡± for patients eligible for thrombolysis was significantly reduced, from 54 minutes before implementation of the alarm to 35 minutes after implementation. Adjusted analysis of covariance demonstrated a significant influence of the intervention (P = .001) on differences in time delay. The proportion of ischemic stroke patients receiving thrombolysis rose from 42 % to 66 % (P = .04). The per-protocol analysis confirmed these results. The implementation of an all-points alarm can result in significant reduction of the time needed for in-hospital pathways for acute?stroke patients.