Bulmer Tessa, Volders David, Kamal Noreen
Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
Interventional & Diagnostic Neuroradiology, QEII Health Sciences Centre, Nova Scotia Health, Halifax, NS, Canada.
Front Neurol. 2021 Mar 15;12:645228. doi: 10.3389/fneur.2021.645228. eCollection 2021.
Stroke is a devastating disease, but it is treatable with alteplase or tissue plasminogen activator (tPA). The effectiveness of tPA is highly time-dependent, meaning rapid treatment is critical. Fast treatment with tPA has been reported in many urban hospitals, but hospitals in rural locations struggle to reduce treatment times. This qualitative study examines current thrombolysis processes in one urban and two rural hospitals in Nova Scotia, Canada, by mapping and comparing the treatment process in these settings for acute ischemic stroke (AIS) patients, and by analyzing the healthcare professionals views on various treatment topics. Structured interviews were conducted with healthcare professionals involved in stroke treatment across the three sites. The interviews focused on the various activities in the thrombolysis treatment at each site. Additionally, participants were asked about the following 10 topics: comfort treating acute ischemic stroke patients; perceptions about tPA; appropriate tPA treatment window; stroke patient priority; tPA availability; patient consent; urban-rural treatment differences; efficiency of their treatment process; treatment delays; and suggested process improvements. Results were analyzed using the Framework Method, as well as through the development of process maps. Twenty three healthcare professionals were interviewed at 2 rural hospitals and 1 urban hospital. Acute ischemic stroke patients are triaged as the highest or urgent priority at each included site. Physicians are more hesitant to treat with tPA in rural settings. A total of 11 urban-rural treatment differences were noted by the rural sites. Additionally, 11 patient-related and 29 system treatment delays were described. A process map was developed for each site, representing the arrival by ambulance and by private vehicle pathways. Guidelines and clear protocols are critical in reducing treatment times and ensuring consistent access to treatment. The majority of treatment delays encountered are system delays, which can be appropriately planned for to reduce delays within the care pathway. There is a general consensus that there is an urban-rural treatment gap for acute ischemic stroke patients in Nova Scotia, and that continuing education is key in rural hospitals to improve Emergency Department (ED) physician comfort with treating patients with tPA.
中风是一种极具破坏性的疾病，但可用阿替普酶或组织纤溶酶原激活剂（tPA）进行治疗。tPA的有效性高度依赖时间，这意味着快速治疗至关重要。许多城市医院已报道了tPA的快速治疗情况，但农村地区的医院在缩短治疗时间方面面临困难。本定性研究通过绘制和比较加拿大新斯科舍省一家城市医院和两家农村医院中急性缺血性中风（AIS）患者的治疗过程，并分析医疗保健专业人员对各种治疗主题的看法，来考察当前的溶栓流程。对参与这三个地点中风治疗的医疗保健专业人员进行了结构化访谈。访谈聚焦于每个地点溶栓治疗中的各种活动。此外，还询问了参与者以下10个主题：治疗急性缺血性中风患者的舒适度；对tPA的看法；合适的tPA治疗窗口；中风患者的优先级；tPA的可获得性；患者同意；城乡治疗差异；治疗过程的效率；治疗延误；以及建议的流程改进。使用框架法以及通过绘制流程图对结果进行了分析。在两家农村医院和一家城市医院对23名医疗保健专业人员进行了访谈。在每个纳入的地点，急性缺血性中风患者都被分诊为最高或紧急优先级。在农村地区，医生使用tPA治疗时更为犹豫。农村地点共指出了11个城乡治疗差异。此外，还描述了11个与患者相关的和29个系统治疗延误。为每个地点绘制了流程图，展示了救护车和私家车到达的路径。指南和明确的方案对于缩短治疗时间和确保获得一致的治疗至关重要。遇到的大多数治疗延误是系统延误，可以进行适当规划以减少护理路径中的延误。人们普遍认为，新斯科舍省急性缺血性中风患者存在城乡治疗差距，农村医院的继续教育是提高急诊科医生使用tPA治疗患者舒适度的关键。
