Klingner Caroline, Günther Albrecht, Brodoehl Stefan, Witte Otto W, Klingner Carsten M
Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Biomagnetic Center, University Hospital, Germany.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):876-881. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.002. Epub 2018 Dec 28.
The outcome of stroke patients can be improved by a rapid initiation of thrombolytic therapy. Here, we sought to determine whether an additional simple but thorough case-based discussion of recent thrombolysed cases with the entire neurologic staff can improve the door-to-needle time without changes to the implemented stroke protocol.
For every performed thrombolysis, a route card, consisting of a timeline with 3 time points and target times, had to be completed by the attending neurologist. Times and reasons for delays were noted. All thrombolysed cases were then reviewed in a 14-day-rhythm with the entire neurologic staff. The responsible stroke consultant gave details and reasons for delays. Possibilities to avoid delays were then discussed with the whole team. All thrombolyses were prospectively recorded and compared with thrombolyses of the 2 preinterventional years. The primary outcome parameter was the door-to-needle time.
The door-to-needle time decreased from 37 minutes in the preintervention period (N = 154) to 28 minutes during the intervention (N = 97; P < .001). Performance was improved for residents (<6 years of neurologic training) as well as for the specialists (>6 years of neurologic training). Improvements in the performance of specialists were significantly greater than those of residents.
The present study demonstrates improved treatment of stroke patients by a simple, non-time-consuming intervention that combines education with a potential increase in staff motivation. This intervention is effective in a tertiary academic stroke center with a previously implemented sophisticated stroke protocol but should also improve treatment delays in primary stroke centers.
迅速开始溶栓治疗可改善中风患者的预后。在此，我们试图确定，与全体神经科医护人员针对近期溶栓病例进行一次额外的简单但全面的病例讨论，能否在不改变已实施的中风治疗方案的情况下缩短门到针时间。
对于每一例进行的溶栓治疗，主治神经科医生必须填写一张路线卡，其中包括一个有3个时间点和目标时间的时间线。记录延迟的时间和原因。然后，每14天与全体神经科医护人员一起回顾所有溶栓病例。负责的中风顾问给出延迟的细节和原因。然后与整个团队讨论避免延迟的可能性。所有溶栓治疗均进行前瞻性记录，并与干预前两年的溶栓治疗进行比较。主要结局参数是门到针时间。
门到针时间从干预前期的37分钟（N = 154）降至干预期间的28分钟（N = 97；P < .001）。住院医师（神经科培训年限<6年）和专科医生（神经科培训年限>6年）的表现均有所改善。专科医生表现的改善明显大于住院医师。
本研究表明，通过一种简单、不耗时的干预措施，将教育与潜在的员工积极性提高相结合，可改善中风患者的治疗。这种干预措施在一个先前已实施复杂中风治疗方案的三级学术中风中心是有效的，而且也应该能改善初级中风中心的治疗延迟情况。
