Bohmann Ferdinand O, Tahtali Damla, Kurka Natalia, Wagner Marlies, You Se-Jong, du Mesnil de Rochemont Richard, Berkefeld Joachim, Hartmetz Ann-Kathrin, Kuhlmann Andrea, Lorenz Matthias W, Schütz Ansgar, Kress Bodo, Henke Christian, Tritt Stephanie, Meyding-Lamadé Uta, Steinmetz Helmuth, Pfeilschifter Waltraud
Department of Neurology, Frankfurt University Hospital, Frankfurt am Main, Germany.
Institute of Neuroradiology, Frankfurt University Hospital, Frankfurt am Main, Germany.
Cerebrovasc Dis. 2018;45(3-4):141-148. doi: 10.1159/000487965. Epub 2018 Mar 27.
Driven by the positive results of randomized, controlled trials of endovascular stroke therapies (EVT) in stroke patients with large vessel occlusion, different approaches to speed up the workflow for EVT candidates are currently being implemented worldwide. We aimed to assess the effect of a simple stroke network-wide workflow improvement project, primarily focusing on i.v. thrombolysis, on process times for patients undergoing EVT.
In 2015, we conducted a network-wide, peer-to-peer acute stroke workflow improvement program for i.v. thrombolysis with the main components of implementing a binding team-based algorithm at every stroke unit of the regional network, educating all stroke teams about non-technical skills and providing a stroke-specific simulation training. Before and after the intervention we recorded periprocedural process times, including patients undergoing EVT at the 3 EVT-capable centers (January - June 2015, n = 80 vs. July 2015 - June 2016, n = 184).
In this multi-centric evaluation of 268 patients receiving EVT, we observed a relevant shortening of the median time from symptom onset to EVT specifically in patients requiring secondary transfer by almost an hour (300 min, 25-75% interquartile range [IQR] 231-381 min to 254 min, IQR 215.25-341 min; p = 0.117), including a reduction of the median door-to-groin time at the EVT-capable center in this patient group by 15.5 min (59 min, IQR 35-102 min to 43.5 min, IQR 27.75-81.25 min; p = 0.063). In patients directly admitted to an EVT-capable center, the median door-to-groin interval was reduced by 10.5 min (125 min, IQR 83.5-170.5 min to 114.5 min, IQR 66.5-151 min; p = 0.167), but a considerable heterogeneity between the centers was observed (p < 0.001).
We show that a simple network-wide workflow improvement program primarily directed at fast i.v. thrombolysis also accelerates process times for EVT candidates and is a promising measure to improve the performance of an entire stroke network.
受血管内卒中治疗（EVT）对大血管闭塞性卒中患者进行随机对照试验所取得的积极成果推动，目前全球正在实施不同方法以加快适合接受EVT治疗患者的工作流程。我们旨在评估一项主要聚焦于静脉溶栓的简单的全卒中网络工作流程改进项目对接受EVT治疗患者的流程时间的影响。
2015年，我们针对静脉溶栓开展了一项全网络、点对点的急性卒中工作流程改进项目，主要组成部分包括在区域网络的每个卒中单元实施基于团队的具有约束力的算法、对所有卒中团队进行非技术技能培训以及提供卒中特异性模拟培训。在干预前后，我们记录了围手术期流程时间，其中包括3个具备EVT治疗能力的中心接受EVT治疗的患者（2015年1月至6月，n = 80例；2015年7月至2016年6月，n = 184例）。
在对268例接受EVT治疗的患者进行的这项多中心评估中，我们观察到从症状发作到接受EVT治疗的中位时间有显著缩短，特别是对于需要二次转运的患者，缩短了近1小时（300分钟，四分位间距[IQR]25 - 75%为231 - 381分钟降至254分钟，IQR为215.25 - 341分钟；p = 0.117），包括该患者组在具备EVT治疗能力的中心从入院到股动脉穿刺的中位时间减少了15.5分钟（59分钟，IQR 35 - 102分钟降至43.5分钟，IQR 27.75 - 81.25分钟；p = 0.063）。对于直接入住具备EVT治疗能力中心的患者，从入院到股动脉穿刺的中位间隔时间减少了10.5分钟（125分钟，IQR 83.5 - 170.5分钟降至114.5分钟，IQR 66.5 - 151分钟；p = 0.167），但各中心之间存在相当大的异质性（p < 0.001）。
我们表明，一项主要针对快速静脉溶栓的简单的全网络工作流程改进项目也能加快适合接受EVT治疗患者的流程时间，并且是提高整个卒中网络性能的一项有前景的措施。
