Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis
Background and Purpose Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Stroke Society
2017-05-01
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| Series: | Journal of Stroke |
| Subjects: | |
| Online Access: | http://www.j-stroke.org/upload/pdf/jos-2016-01802.pdf |
| _version_ | 1819172413206691840 |
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| author | Sang-Beom Jeon Seung Mok Ryoo Deok Hee Lee Sun U. Kwon Seongsoo Jang Eun-Jae Lee Sang Hun Lee Jung Hee Han Mi Jeong Yoon Soo Jeong Young-Uk Cho Sungyang Jo Seung-Bok Lim Joong-Goo Kim Han-Bin Lee Seung Chai Jung Kye Won Park Min-Hwan Lee Dong-Wha Kang Dae Chul Suh Jong S. Kim |
| author_facet | Sang-Beom Jeon Seung Mok Ryoo Deok Hee Lee Sun U. Kwon Seongsoo Jang Eun-Jae Lee Sang Hun Lee Jung Hee Han Mi Jeong Yoon Soo Jeong Young-Uk Cho Sungyang Jo Seung-Bok Lim Joong-Goo Kim Han-Bin Lee Seung Chai Jung Kye Won Park Min-Hwan Lee Dong-Wha Kang Dae Chul Suh Jong S. Kim |
| author_sort | Sang-Beom Jeon |
| collection | DOAJ |
| description | Background and Purpose Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. Methods We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. Results A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). Conclusions SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours. |
| first_indexed | 2024-12-22T20:06:47Z |
| format | Article |
| id | doaj.art-4138d347306b4e2ab076dd8095aa2e8b |
| institution | Directory Open Access Journal |
| issn | 2287-6391 2287-6405 |
| language | English |
| last_indexed | 2024-12-22T20:06:47Z |
| publishDate | 2017-05-01 |
| publisher | Korean Stroke Society |
| record_format | Article |
| series | Journal of Stroke |
| spelling | doaj.art-4138d347306b4e2ab076dd8095aa2e8b2022-12-21T18:14:06ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052017-05-0119219620410.5853/jos.2016.01802186Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke ThrombolysisSang-Beom Jeon0Seung Mok Ryoo1Deok Hee Lee2Sun U. Kwon3Seongsoo Jang4Eun-Jae Lee5Sang Hun Lee6Jung Hee Han7Mi Jeong Yoon8Soo Jeong9Young-Uk Cho10Sungyang Jo11Seung-Bok Lim12Joong-Goo Kim13Han-Bin Lee14Seung Chai Jung15Kye Won Park16Min-Hwan Lee17Dong-Wha Kang18Dae Chul Suh19Jong S. Kim20 Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Nursing, Asan Medical Center, Seoul, Korea Department of Nursing, Asan Medical Center, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Nursing, Asan Medical Center, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaBackground and Purpose Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. Methods We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. Results A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). Conclusions SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.http://www.j-stroke.org/upload/pdf/jos-2016-01802.pdfcerebral infarctionthrombolytic therapytissue plasminogen activator |
| spellingShingle | Sang-Beom Jeon Seung Mok Ryoo Deok Hee Lee Sun U. Kwon Seongsoo Jang Eun-Jae Lee Sang Hun Lee Jung Hee Han Mi Jeong Yoon Soo Jeong Young-Uk Cho Sungyang Jo Seung-Bok Lim Joong-Goo Kim Han-Bin Lee Seung Chai Jung Kye Won Park Min-Hwan Lee Dong-Wha Kang Dae Chul Suh Jong S. Kim Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis Journal of Stroke cerebral infarction thrombolytic therapy tissue plasminogen activator |
| title | Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis |
| title_full | Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis |
| title_fullStr | Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis |
| title_full_unstemmed | Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis |
| title_short | Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis |
| title_sort | multidisciplinary approach to decrease in hospital delay for stroke thrombolysis |
| topic | cerebral infarction thrombolytic therapy tissue plasminogen activator |
| url | http://www.j-stroke.org/upload/pdf/jos-2016-01802.pdf |
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