A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment
Introduction: Recent analyses emphasise that The Benchmark Stroke Door-to-Needle Time (DNT) should be 30 min. 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...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier España
2021-09-01
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| Series: | Neurología (English Edition) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2173580820300134 |
| _version_ | 1818643959911546880 |
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| author | A.M. Iglesias Mohedano A. García Pastor F. Díaz Otero P. Vázquez Alen M.A. Martín Gómez P. Simón Campo P. Salgado Cámara E. Esteban de Antonio E. Lázaro García C. Funes Molina M. del Valle Diéguez J. Saura Lorente Y. Fernández Bullido A. Gil Nuñez |
| author_facet | A.M. Iglesias Mohedano A. García Pastor F. Díaz Otero P. Vázquez Alen M.A. Martín Gómez P. Simón Campo P. Salgado Cámara E. Esteban de Antonio E. Lázaro García C. Funes Molina M. del Valle Diéguez J. Saura Lorente Y. Fernández Bullido A. Gil Nuñez |
| author_sort | A.M. Iglesias Mohedano |
| collection | DOAJ |
| description | Introduction: Recent analyses emphasise that The Benchmark Stroke Door-to-Needle Time (DNT) should be 30 min. 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 27 min after the protocol was fully implemented (a 48% reduction on previous door-to-needle time [52 min], P < .001)]. Median door-to-needle time was lower when pre-hospital code stroke was activated (22 min). 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 30 min and corrected previously identified delay factors. Furthermore, overall time from onset to treatment was also reduced and more stroke patients were treated within 90 min of symptom onset. Resumen: Introducción: El objetivo del tiempo puerta-aguja en el ictus isquémico agudo tratado con trombólisis intravenosa (TIV) tiende a situarse actualmente en los 30 min. Determinamos si un nuevo protocolo de actuación intrahospitalario es eficaz para reducir el intervalo puerta-aguja y corregir los factores de demora previamente identificados. Material y métodos: En 2014 se implantaron gradualmente unas medidas diseñadas para acortar los tiempos de actuación intrahospitalarios en los pacientes tratados con TIV. Se compararon los tiempos de actuación antes (2009-2012) y después (febrero 2014-abril 2017) de la introducción del nuevo protocolo. Resultados: Se incluyeron 239 pacientes antes y 222 después. Cuando todas las medidas fueron introducidas, la mediana global de tiempo puerta-aguja fue de 27 min (previa 52 min, 48% menos, p < 0,001) y de 22 min cuando se activó el código ictus extrahospitalario. El tiempo global al tratamiento (inicio-aguja) se redujo en 26 min de mediana (p < 0,001). En el período postintervención ya no se objetivó el «efecto de fin de ventana» (p = 0,98). Aunque la angio-TC antes de la TIV continuó retrasando los tiempos de actuación (p < 0,001), tras el nuevo protocolo, esta prueba se realizó después del inicio del tratamiento en la mayoría de los casos. Conclusiones: La reorganización intrahospitalaria y la colaboración multidisciplinar han situado la mediana de tiempo puerta-aguja por debajo de los 30 min y han corregido los factores de demora identificados previamente. Además, se ha reducido el tiempo global al tratamiento y una mayor proporción de pacientes son tratados en los primeros 90 min desde el inicio de los síntomas. |
| first_indexed | 2024-12-17T00:07:15Z |
| format | Article |
| id | doaj.art-a883a34171354917aa032a8e62ea918a |
| institution | Directory Open Access Journal |
| issn | 2173-5808 |
| language | English |
| last_indexed | 2024-12-17T00:07:15Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier España |
| record_format | Article |
| series | Neurología (English Edition) |
| spelling | doaj.art-a883a34171354917aa032a8e62ea918a2022-12-21T22:10:55ZengElsevier EspañaNeurología (English Edition)2173-58082021-09-01367487494A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatmentA.M. Iglesias Mohedano0A. García Pastor1F. Díaz Otero2P. Vázquez Alen3M.A. Martín Gómez4P. Simón Campo5P. Salgado Cámara6E. Esteban de Antonio7E. Lázaro García8C. Funes Molina9M. del Valle Diéguez10J. Saura Lorente11Y. Fernández Bullido12A. Gil Nuñez13Sección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Corresponding author.Sección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurorradiología-Radiología Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurorradiología-Radiología Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurorradiología-Radiología Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurorradiología-Radiología Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, SpainSección de Neurología Vascular, Unidad de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, SpainIntroduction: Recent analyses emphasise that The Benchmark Stroke Door-to-Needle Time (DNT) should be 30 min. 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 27 min after the protocol was fully implemented (a 48% reduction on previous door-to-needle time [52 min], P < .001)]. Median door-to-needle time was lower when pre-hospital code stroke was activated (22 min). 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 30 min and corrected previously identified delay factors. Furthermore, overall time from onset to treatment was also reduced and more stroke patients were treated within 90 min of symptom onset. Resumen: Introducción: El objetivo del tiempo puerta-aguja en el ictus isquémico agudo tratado con trombólisis intravenosa (TIV) tiende a situarse actualmente en los 30 min. Determinamos si un nuevo protocolo de actuación intrahospitalario es eficaz para reducir el intervalo puerta-aguja y corregir los factores de demora previamente identificados. Material y métodos: En 2014 se implantaron gradualmente unas medidas diseñadas para acortar los tiempos de actuación intrahospitalarios en los pacientes tratados con TIV. Se compararon los tiempos de actuación antes (2009-2012) y después (febrero 2014-abril 2017) de la introducción del nuevo protocolo. Resultados: Se incluyeron 239 pacientes antes y 222 después. Cuando todas las medidas fueron introducidas, la mediana global de tiempo puerta-aguja fue de 27 min (previa 52 min, 48% menos, p < 0,001) y de 22 min cuando se activó el código ictus extrahospitalario. El tiempo global al tratamiento (inicio-aguja) se redujo en 26 min de mediana (p < 0,001). En el período postintervención ya no se objetivó el «efecto de fin de ventana» (p = 0,98). Aunque la angio-TC antes de la TIV continuó retrasando los tiempos de actuación (p < 0,001), tras el nuevo protocolo, esta prueba se realizó después del inicio del tratamiento en la mayoría de los casos. Conclusiones: La reorganización intrahospitalaria y la colaboración multidisciplinar han situado la mediana de tiempo puerta-aguja por debajo de los 30 min y han corregido los factores de demora identificados previamente. Además, se ha reducido el tiempo global al tratamiento y una mayor proporción de pacientes son tratados en los primeros 90 min desde el inicio de los síntomas.http://www.sciencedirect.com/science/article/pii/S2173580820300134Tiempo puerta-agujaTrombolisis intravenosaTratamiento del ictusProtocolo intrahospitalarioIctus agudoIctus isquémico |
| spellingShingle | A.M. Iglesias Mohedano A. García Pastor F. Díaz Otero P. Vázquez Alen M.A. Martín Gómez P. Simón Campo P. Salgado Cámara E. Esteban de Antonio E. Lázaro García C. Funes Molina M. del Valle Diéguez J. Saura Lorente Y. Fernández Bullido A. Gil Nuñez A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment Neurología (English Edition) Tiempo puerta-aguja Trombolisis intravenosa Tratamiento del ictus Protocolo intrahospitalario Ictus agudo Ictus isquémico |
| title | A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment |
| title_full | A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment |
| title_fullStr | A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment |
| title_full_unstemmed | A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment |
| title_short | A new protocol reduces median door-to-needle time to the benchmark of 30 minutes in acute stroke treatment |
| title_sort | new protocol reduces median door to needle time to the benchmark of 30 minutes in acute stroke treatment |
| topic | Tiempo puerta-aguja Trombolisis intravenosa Tratamiento del ictus Protocolo intrahospitalario Ictus agudo Ictus isquémico |
| url | http://www.sciencedirect.com/science/article/pii/S2173580820300134 |
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