Schregel Katharina, Behme Daniel, Tsogkas Ioannis, Knauth Michael, Maier Ilko, Karch André, Mikolajczyk Rafael, Hinz José, Liman Jan, Psychogios Marios-Nikos
Department of Neuroradiology, University Medicine Goettingen, Goettingen, Germany.
Department of Neurology, University Medicine Goettingen, Goettingen, Germany.
PLoS One. 2016 Dec 30;11(12):e0169192. doi: 10.1371/journal.pone.0169192. eCollection 2016.
Endovascular treatment of acute ischemic stroke has become standard of care for patients with large artery occlusion. Early restoration of blood flow is crucial for a good clinical outcome. We introduced an interdisciplinary standard operating procedure (SOP) between neuroradiologists, neurologists and anesthesiologists in order to streamline patient management. This study analyzes the effect of optimized workflow on periprocedural timings and its potential influence on clinical outcome. Data were extracted from a prospectively maintained university hospital stroke database. The standard operating procedure was established in February 2014. Of the 368 acute stroke patients undergoing endovascular treatment between 2008 and 2015, 278 patients were treated prior to and 90 after process optimization. Outcome measures were periprocedural time intervals and residual functional impairment. After implementation of the SOP, time from symptom onset to reperfusion was significantly reduced (median 264 min prior and 211 min after SOP-introduction (IQR 228-32 min and 161-278 min, respectively); P<0.001). Especially faster supply of imaging and prompt transfer of patients to the angiography suite contributed to this effect. Time between hospital admission and groin puncture was reduced by half after process optimization (median 64 min after versus 121 min prior to SOP-introduction (IQR 54-77 min and 96-161 min, respectively); P<0.001). Clinical outcome was significantly better after workflow optimization as measured with the modified Rankin Scale (common odds ratio (OR) 0.56; 95% CI 0.32-0.98; P = 0.038). Optimization of workflow and interdisciplinary teamwork significantly improved the outcome of patients with acute ischemic stroke due to a significant reduction of in-hospital examination, transportation, imaging and treatment times.
急性缺血性卒中的血管内治疗已成为大动脉闭塞患者的标准治疗方法。早期恢复血流对于良好的临床结局至关重要。我们引入了神经放射科医生、神经科医生和麻醉科医生之间的跨学科标准操作程序（SOP），以简化患者管理。本研究分析了优化工作流程对围手术期时间安排的影响及其对临床结局的潜在影响。数据来自前瞻性维护的大学医院卒中数据库。标准操作程序于2014年2月制定。在2008年至2015年间接受血管内治疗的368例急性卒中患者中，278例在流程优化之前接受治疗，90例在流程优化之后接受治疗。结局指标为围手术期时间间隔和残余功能障碍。实施SOP后，从症状发作到再灌注的时间显著缩短（SOP引入前中位数为264分钟，引入后为211分钟（四分位间距分别为228 - 32分钟和161 - 278分钟）；P<0.001）。尤其是更快地提供影像学检查以及将患者迅速转运至血管造影室促成了这一效果。流程优化后，入院至腹股沟穿刺的时间减少了一半（SOP引入后中位数为64分钟，引入前为121分钟（四分位间距分别为54 - 77分钟和96 - 161分钟）；P<0.001）。用改良Rankin量表测量，工作流程优化后的临床结局显著更好（共同比值比（OR）为0.56；95%置信区间为0.32 - 0.98；P = 0.038）。工作流程的优化和跨学科团队合作显著改善了急性缺血性卒中患者的结局，这是因为住院检查、转运、影像学检查和治疗时间显著减少。
