Pines Andrew R, Das Devika M, Bhatt Shubhang K, Shiue Harn J, Dawit Sara, Vanderhye Vanesa K, Sands Kara A
Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ.
Department of Pharmacy, Mayo Clinic, Phoenix, AZ.
Mayo Clin Proc Innov Qual Outcomes. 2020 Dec 10;4(6):657-666. doi: 10.1016/j.mayocpiqo.2020.07.009. eCollection 2020 Dec.
To identify barriers to inpatient alteplase administration and implement an interdisciplinary program to reduce time to systemic thrombolysis.
Compared with patients presenting to the emergency department with an acute ischemic stroke (AIS), inpatients are delayed in receiving alteplase for systemic thrombolysis. Institutional AIS metrics were extracted from the electronic medical records of patients presenting as an inpatient stroke alert. All patients who received alteplase for AIS were included in the analysis. A gap analysis was used to assess institutional deficiencies. An interdisciplinary intervention was initiated to address these deficiencies. Efficacy was measured with pre- and postintervention surveys and institutional AIS metric analysis. Statistical significance was determined using the Student test. We identified 5 patients (mean age, 73 years; 100% (5/5) male; 80% (4/5) white) who met inclusion criteria for the preintervention period (January 1, 2017, to December 31, 2017) and 10 patients (mean age, 71 years; 50% male; 80% white) for the postintervention period (October 31, 2018, to July 1, 2020).
We found barriers to rapid delivery of thrombolytic treatment to include alteplase availability and comfort with bedside reconstitution. Interdisciplinary intervention strategies consisted of stocking alteplase on additional floors as well as structured education and hands-on alteplase reconstitution simulations for resident physicians. The mean time from stroke alert to thrombolysis was shorter postintervention than preintervention (57.4 minutes vs 77.8 minutes; =.03).
A coordinated interdisciplinary approach is effective in reducing time to systemic thrombolysis in patients experiencing AIS in the inpatient setting. A similar program could be implemented at other institutions to improve AIS treatment.
确定住院患者使用阿替普酶的障碍，并实施一项跨学科计划以缩短全身溶栓时间。
与因急性缺血性卒中（AIS）就诊于急诊科的患者相比，住院患者接受阿替普酶进行全身溶栓的时间有所延迟。从作为住院卒中警报就诊的患者电子病历中提取机构AIS指标。所有接受阿替普酶治疗AIS的患者均纳入分析。采用差距分析评估机构缺陷。启动跨学科干预以解决这些缺陷。通过干预前后的调查和机构AIS指标分析来衡量疗效。使用学生t检验确定统计学显著性。我们确定了5例符合干预前期（2017年1月1日至2017年12月31日）纳入标准的患者（平均年龄73岁；100%（5/5）为男性；80%（4/5）为白人）以及10例符合干预后期（2018年10月31日至2020年7月1日）纳入标准的患者（平均年龄71岁；50%为男性；80%为白人）。
我们发现快速进行溶栓治疗的障碍包括阿替普酶的可获得性以及对床边复溶的熟悉程度。跨学科干预策略包括在更多楼层储备阿替普酶，以及为住院医师提供结构化教育和阿替普酶复溶的实践模拟。干预后从卒中警报至溶栓的平均时间比干预前缩短（57.4分钟对77.8分钟；P =.03）。
在住院环境中，协调一致的跨学科方法对于缩短AIS患者全身溶栓时间是有效的。其他机构可实施类似计划以改善AIS治疗。
