Mainali Shraddha, Stutzman Sonja, Sengupta Samarpita, Dirickson Amanda, Riise Laura, Jones Donald, Yang Julian, Olson DaiWai M
Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas.
Hospital Accreditation Services, American Heart Association, Dallas, Texas.
J Stroke Cerebrovasc Dis. 2017 May;26(5):987-991. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.007. Epub 2016 Dec 21.
Acute stroke care requires rapid assessment and intervention. Replacing traditional sequential algorithms in stroke care with parallel processing using telestroke consultation could be useful in the management of acute stroke patients. The purpose of this study was to assess the feasibility of a nurse-driven acute stroke protocol using a parallel processing model.
This is a prospective, nonrandomized, feasibility study of a quality improvement initiative. Stroke team members had a 1-month training phase, and then the protocol was implemented for 6 months and data were collected on a "run-sheet." The primary outcome of this study was to determine if a nurse-driven acute stroke protocol is feasible and assists in decreasing door to needle (intravenous tissue plasminogen activator [IV-tPA]) times.
Of the 153 stroke patients seen during the protocol implementation phase, 57 were designated as "level 1" (symptom onset <4.5 hours) strokes requiring acute stroke management. Among these strokes, 78% were nurse-driven, and 75% of the telestroke encounters were also nurse-driven. The average door to computerized tomography time was significantly reduced in nurse-driven codes (38.9 minutes versus 24.4 minutes; P < .04).
The use of a nurse-driven protocol is feasible and effective. When used in conjunction with a telestroke specialist, it may be of value in improving patient outcomes by decreasing the time for door to decision for IV-tPA.
急性中风护理需要快速评估和干预。使用远程中风会诊的并行处理取代中风护理中的传统顺序算法，可能有助于急性中风患者的管理。本研究的目的是评估使用并行处理模型的护士驱动急性中风方案的可行性。
这是一项关于质量改进计划的前瞻性、非随机可行性研究。中风团队成员有1个月的培训阶段，然后该方案实施6个月，并在“运行表”上收集数据。本研究的主要结果是确定护士驱动的急性中风方案是否可行，并有助于缩短门到针（静脉注射组织纤溶酶原激活剂[IV-tPA]）时间。
在方案实施阶段就诊的153例中风患者中，57例被指定为需要急性中风管理的“1级”（症状发作<4.5小时）中风。在这些中风中，78%是由护士驱动的，75%的远程中风会诊也是由护士驱动的。护士驱动的病例中，平均门到计算机断层扫描时间显著缩短（38.9分钟对24.4分钟；P < 0.04）。
使用护士驱动的方案是可行且有效的。与远程中风专家联合使用时，通过缩短IV-tPA的门到决策时间，可能对改善患者预后有价值。
