Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Red Deer Regional Hospital Centre, Red Deer, Alberta, Canada.
Can J Neurol Sci. 2019 Jan;46(1):51-56. doi: 10.1017/cjn.2018.368. Epub 2018 Dec 5.
Alteplase is an effective treatment for ischaemic stroke patients, and it is widely available at all primary stroke centres. The effectiveness of alteplase is highly time-dependent. Large tertiary centres have reported significant improvements in their door-to-needle (DTN) times. However, these same improvements have not been reported at community hospitals.
Red Deer Regional Hospital Centre (RDRHC) is a community hospital of 370 beds that serves approximately 150,000 people in their acute stroke catchment area. The RDRHC participated in a provincial DTN improvement initiative, and implemented a streamlined algorithm for the treatment of stroke patients. During this intervention period, they implemented the following changes: early alert of an incoming acute stroke patient to the neurologist and care team, meeting the patient immediately upon arrival, parallel work processes, keeping the patient on the Emergency Medical Service stretcher to the CT scanner, and administering alteplase in the imaging area. Door-to-needle data were collected from July 2007 to December 2017.
A total of 289 patients were treated from July 2007 to December 2017. In the pre-intervention period, 165 patients received alteplase and the median DTN time was 77 minutes [interquartile range (IQR): 60-103 minutes]; in the post-intervention period, 104 patients received alteplase and the median DTN time was 30 minutes (IQR: 22-42 minutes) (p < 0.001). The annual number of patients that received alteplase increased from 9 to 29 in the pre-intervention period to annual numbers of 41 to 63 patients in the post-intervention period.
Community hospitals staffed with community neurologists can achieve median DTN times of 30 minutes or less.
阿替普酶是治疗缺血性脑卒中患者的有效药物，所有初级卒中中心均有广泛应用。阿替普酶的疗效与时间密切相关。大型三级中心报告称，其门到针（DTN）时间有显著改善。然而，社区医院并未报告相同的改善。
红鹿地区医院中心（RDRHC）是一家拥有 370 张床位的社区医院，服务于其急性脑卒中收治区域约 15 万人。RDRHC 参与了省级 DTN 改善计划，并实施了简化的脑卒中患者治疗算法。在此干预期间，他们实施了以下变革：急性脑卒中患者传入时向神经科医生和护理团队发出早期警报，患者到达时立即接诊，并行工作流程，让患者躺在急救医疗服务担架上直接进入 CT 扫描室，在影像区给予阿替普酶。从 2007 年 7 月至 2017 年 12 月收集门到针数据。
2007 年 7 月至 2017 年 12 月共治疗了 289 例患者。在干预前期间，165 例患者接受了阿替普酶治疗，中位数 DTN 时间为 77 分钟（IQR：60-103 分钟）；在干预后期间，104 例患者接受了阿替普酶治疗，中位数 DTN 时间为 30 分钟（IQR：22-42 分钟）（p < 0.001）。干预前期间每年接受阿替普酶治疗的患者数量从 9 例增加到 29 例，而干预后期间每年接受阿替普酶治疗的患者数量从 41 例增加到 63 例。
由社区神经科医生组成的社区医院可以将 DTN 时间中位数控制在 30 分钟或更短。
