Back to Search Start Over

Improving treatment times for patients with in-hospital stroke using a standardized protocol.

Authors :
Koge J
Matsumoto S
Nakahara I
Ishii A
Hatano T
Sadamasa N
Kai Y
Ando M
Saka M
Chihara H
Takita W
Tokunaga K
Kamata T
Nishi H
Hashimoto T
Tsujimoto A
Kira JI
Nagata I
Source :
Journal of the neurological sciences [J Neurol Sci] 2017 Oct 15; Vol. 381, pp. 68-73. Date of Electronic Publication: 2017 Aug 18.
Publication Year :
2017

Abstract

Background: Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol.<br />Methods: Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008-March 2014) and after implementation (April 2014-December 2016).<br />Results: Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5min, p<0.01) and to first neuroimaging (50 vs. 26.5min, p<0.01) and in the median time from first neuroimaging to intravenous thrombolysis (45 vs. 16min, p=0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53min, p=0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods.<br />Conclusion: Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety.<br /> (Copyright © 2017 Elsevier B.V. All rights reserved.)

Details

Language :
English
ISSN :
1878-5883
Volume :
381
Database :
MEDLINE
Journal :
Journal of the neurological sciences
Publication Type :
Academic Journal
Accession number :
28991718
Full Text :
https://doi.org/10.1016/j.jns.2017.08.023