From the Departments of Neurology and Medicine (A.M., L.W., M.U., N.Y., B.Y., P.H., S.M.D., B.C.V.C), Nursing (L.W.), and Emergency Department (M.T.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; and Department of Neurology (A.M.), Helsinki University Central Hospital, Finland.
Neurology. 2013 Sep 17;81(12):1071-6. doi: 10.1212/WNL.0b013e3182a4a4d2. Epub 2013 Aug 14.
To test the transferability of the Helsinki stroke thrombolysis model that achieved a median 20-minute door-to-needle time (DNT) to an Australian health care setting.
The existing "code stroke" model at the Royal Melbourne Hospital was evaluated and restructured to include key components of the Helsinki model: 1) ambulance prenotification with patient details alerting the stroke team to meet the patient on arrival; 2) patients transferred directly from triage onto the CT table on the ambulance stretcher; and 3) tissue plasminogen activator (tPA) delivered in CT immediately after imaging. We analyzed our prospective, consecutive tPA registry for effects of these protocol changes on our DNT after implementation during business hours (8 am to 5 pm Monday-Friday) from May 2012.
There were 48 patients treated with tPA in the 8 months after the protocol change. Compared with 85 patients treated in 2011, the median (interquartile range) DNT was reduced from 61 (43-75) minutes to 46 (24-79) minutes (p = 0.040). All of the effect came from the change in the in-hours DNT, down from 43 (33-59) to 25 (19-48) minutes (p = 0.009), whereas the out-of-hours delays remain unchanged, from 67 (55-82) to 62 (44-95) minutes (p = 0.835).
We demonstrated rapid transferability of an optimized tPA protocol to a different health care setting. With the cooperation of ambulance, emergency, and stroke teams, we succeeded in the absence of a dedicated neurologic emergency department or electronic patient records, which are features of the Finnish system. The next challenge is providing the same service out-of-hours.
检验赫尔辛基溶栓模型的可转移性，该模型实现了中位数为 20 分钟的门到针时间（DNT），并将其应用于澳大利亚的医疗保健环境。
评估并重构了皇家墨尔本医院现有的“卒中代码”模型，纳入了赫尔辛基模型的关键组成部分：1）救护车预通知，患者详细信息通知卒中团队在到达时迎接患者；2）患者直接从分诊转移到救护车上的 CT 台；3）在 CT 后立即在图像上给予组织型纤溶酶原激活剂（tPA）。我们分析了我们前瞻性的、连续的 tPA 注册数据，以了解这些方案变更在实施后（周一至周五上午 8 点至下午 5 点）对我们的 DNT 的影响。
方案变更后 8 个月内有 48 例患者接受了 tPA 治疗。与 2011 年治疗的 85 例患者相比，中位数（四分位距）DNT 从 61（43-75）分钟减少至 46（24-79）分钟（p = 0.040）。所有效果都来自于工作时间内 DNT 的变化，从 43（33-59）分钟降至 25（19-48）分钟（p = 0.009），而工作时间之外的延迟保持不变，从 67（55-82）分钟降至 62（44-95）分钟（p = 0.835）。
我们证明了优化的 tPA 方案可以快速转移到不同的医疗保健环境。在救护车、急诊和卒中团队的合作下，我们成功地在没有专门的神经急救部门或电子患者记录的情况下实现了这一目标，这些都是芬兰系统的特点。下一个挑战是在非工作时间提供相同的服务。
