Kendall Jason, Dutta Dipankar, Brown Elsa
Department of Emergency Medicine, North Bristol NHS Trust, Bristol, UK.
Stroke Service, Gloucestershire Royal Hospital, Great Western Road, Gloucester, UK.
Emerg Med J. 2015 Feb;32(2):100-4. doi: 10.1136/emermed-2013-202993. Epub 2013 Sep 24.
The Stroke 90 Project was implemented to reduce delays to stroke thrombolysis and involved 7 hospitals and 2 ambulance services in the Avon, Gloucester, Wiltshire and Somerset regional network. Interventions included a direct to CT (DtoCT) protocol for paramedics to transport patients directly to the CT scanner. Coincidentally, there were severe winter pressures on all participating emergency departments during this period.
Comparison of data from 2 groups across all 7 hospitals: preintervention (n=136) and postintervention patients (n=215) thrombolysed from August 2012 to January 2013. The χ(2) test, t tests, multiple and linear regression were used for analysis.
Ambulance transport times were 56.8 min for preintervention versus 57.5 min for postintervention patients (p=0.78). 11.7% of preintervention patients received thrombolysis within 90 min of call for help versus 23.7% of postintervention cases (p=0.0135). 44% of postintervention patients entered the DtoCT pathway and achieved a mean reduction in door to CT time of 17 min (95% CI 11.5 to 21.5; p<0.0001) and a 19 min reduction in door to needle time (95% CI 10.8 to 26.8; p<0.0001). CT to needle times were 43.8 min preintervention and 42.1 min postintervention (p=0.57).
The DtoCT pathway was successful in reducing delays to thrombolysis and should be implemented routinely. The call to door and CT to needle times were not improved by our interventions and further work is required to streamline these. Factors beyond the control of most hospitals may play a role in delaying treatment, but local changes can be implemented to mitigate this.
实施“卒中90计划”旨在减少卒中溶栓延迟，该计划涉及埃文、格洛斯特、威尔特郡和萨默塞特地区网络中的7家医院和2家急救服务机构。干预措施包括为护理人员制定直接送往CT（DtoCT）方案，以便将患者直接送往CT扫描仪。巧合的是，在此期间，所有参与的急诊科都面临着严峻的冬季压力。
比较2012年8月至2013年1月期间在所有7家医院接受溶栓治疗的两组患者的数据：干预前（n = 136）和干预后患者（n = 215）。采用χ²检验、t检验、多元回归和线性回归进行分析。
干预前患者的救护车运送时间为56.8分钟，干预后患者为57.5分钟（p = 0.78）。11.7%的干预前患者在呼救后90分钟内接受了溶栓治疗，而干预后病例为23.7%（p = 0.0135）。44%的干预后患者进入了DtoCT流程，平均门到CT时间减少了17分钟（95%置信区间11.5至21.5；p < 0.0001），门到针时间减少了19分钟（95%置信区间10.8至26.8；p < 0.0001）。干预前门到针时间为43.8分钟，干预后为42.1分钟（p = 0.57）。
DtoCT流程成功减少了溶栓延迟，应常规实施。我们的干预措施并未改善呼叫到门和CT到针的时间，需要进一步开展工作以优化这些环节。大多数医院无法控制的因素可能在延迟治疗方面起作用，但可以实施局部改变以减轻这种情况。
