Moreira Tiago, Furnica Alexander, Daemen Elke, Mazya Michael V, Sjöstrand Christina, Kaijser Magnus, van Loenen Evert
Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Front Neurol. 2021 Nov 24;12:741551. doi: 10.3389/fneur.2021.741551. eCollection 2021.
Starting reperfusion therapies as early as possible in acute ischemic strokes are of utmost importance to improve outcomes. The Comprehensive Stroke Centers (CSCs) can use surveys, shadowing personnel or perform journal analysis to improve logistics, which can be labor intensive, lack accuracy, and disturb the staff by requiring manual intervention. The aim of this study was to measure transport times, facility usage, and patient-staff colocalization with an automated real-time location system (RTLS). We tested IR detection of patient wristbands and staff badges in parallel with a period when the triage of stroke patients was changed from admission to the emergency room (ER) to direct admission to neuroradiology. In total, 281 patients were enrolled. In 242/281 (86%) of cases, stroke patient logistics could be detected. Consistent patient-staff colocalizations were detected in 177/281 (63%) of cases. Bypassing the ER led to a significant decrease in median time neurologists spent with patients (from 15 to 9 min), but to an increase of the time nurses spent with patients (from 13 to 22 min; = 0.036). Ischemic stroke patients used the most staff time (median 25 min) compared to hemorrhagic stroke patients (median 13 min) and stroke mimics (median 15 min). Time spent with patients increased for nurses, but decreased for neurologists after direct triage to the CSC. While lower in-hospital transport times were detected, time spent in neuroradiology (CT room and waiting) remained unchanged. The RTLS could be used to measure the timestamps in stroke pathways and assist in staff allocation.
在急性缺血性卒中患者中尽早开始再灌注治疗对于改善预后至关重要。综合卒中中心（CSC）可以通过调查、人员跟踪或进行期刊分析来改善后勤保障，但这些方法可能劳动强度大、缺乏准确性，且需要人工干预，会干扰工作人员。本研究的目的是使用自动实时定位系统（RTLS）来测量转运时间、设施使用情况以及患者与工作人员的同地协作情况。我们在卒中患者分诊从入院至急诊室（ER）改为直接入住神经放射科的期间，同时测试了患者腕带和工作人员胸牌的红外检测。总共纳入了281例患者。在281例中的242例（86%）病例中，能够检测到卒中患者的后勤保障情况。在281例中的177例（63%）病例中检测到了一致的患者与工作人员同地协作情况。绕过急诊室导致神经科医生与患者相处的中位时间显著减少（从15分钟降至9分钟），但护士与患者相处的时间增加了（从13分钟增至22分钟；P = 0.036）。与出血性卒中患者（中位时间13分钟）和疑似卒中患者（中位时间15分钟）相比，缺血性卒中患者占用工作人员的时间最多（中位时间25分钟）。直接分诊至CSC后，护士与患者相处的时间增加了，但神经科医生与患者相处的时间减少了。虽然检测到院内转运时间缩短，但在神经放射科（CT室和等待时间）花费的时间保持不变。RTLS可用于测量卒中流程中的时间戳，并协助进行人员分配。
