J Neurosci Nurs. 2021 Jun 1;53(3):134-139. doi: 10.1097/JNN.0000000000000590.
There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention is essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous (IV) thrombolytic. The objective of this pilot study is to evaluate factors of acute stroke care in the emergency department (ED) and their impact on IV alteplase administration. METHODS: A sample of 89 AIS patients who received IV alteplase from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. RESULTS: The mean door-to-needle time is 53.74 (38.06) minutes, with 74.2% of patients arriving to the ED via emergency medical services and 25.8% having a stroke nurse present during IV alteplase administration. Mode of arrival (P = .001) and having a stroke nurse present (P = .022) are significant predictors of door-to-needle time in the ED. CONCLUSION: Although many factors can influence door-to-needle times in the ED, we did not find National Institutes of Health Stroke Scale score on arrival and time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV alteplase administration, therefore emphasizing the importance of using emergency medical services. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV alteplase administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and improving patient outcomes.
越来越重视发现导致急性缺血性脑卒中（AIS）患者干预时间延迟的因素，因为快速干预对于改善患者预后至关重要。这些患者的管理涉及多学科努力和质量改进措施，以安全地增加静脉（IV）溶栓治疗。本初步研究的目的是评估急诊科（ED）急性脑卒中护理的相关因素及其对 IV 阿替普酶给药的影响。
选择来自单一学术医疗机构的 89 名接受 IV 阿替普酶治疗的 AIS 患者进行回顾性分析。使用描述性统计和多元回归分析系统特征（是否存在脑卒中护士以及一天中的时间）和患者特征（到达方式和到达时的国立卫生研究院卒中量表评分），以解决研究问题。
平均门到针时间为 53.74（38.06）分钟，74.2%的患者通过紧急医疗服务到达 ED，25.8%的患者在 IV 阿替普酶给药时存在脑卒中护士。到达方式（P=0.001）和存在脑卒中护士（P=0.022）是 ED 中门到针时间的显著预测因素。
尽管许多因素会影响 ED 中的门到针时间，但我们发现到达时的国立卫生研究院卒中量表评分和一天中的时间并非显著因素。通过个人车辆到达 ED 的患者将延迟 IV 阿替普酶给药，因此强调使用紧急医疗服务的重要性。也许更重要的是，包括增加专门的脑卒中护士在内的协作努力显著缩短了 AIS 患者的 IV 阿替普酶给药时间。通过这种专门的角色，可以加快 AIS 患者的分诊和更有效地管理，从而缩短干预时间并改善患者预后。
