Radiology, University Hospital Waterford, Waterford, Ireland
Gerontology, University Hospital Waterford, Waterford, Ireland.
BMJ Open Qual. 2022 Jan;11(1). doi: 10.1136/bmjoq-2021-001429.
This paper describes a stroke quality improvement (QI) project in a primary stroke centre in a 431-bed hospital serving a local population of 114 000 people. Approximately 170 acute strokes are treated each year in a seven-bed stroke unit managed by three geriatricians with a subspecialty interest in stroke. 24-hour CT radiology service is available. Endovascular thrombectomy (EVT) is performed by neuro-interventional radiology at one of two comprehensive stroke centres located 90-120 min away.In 2018, as part of a national collaborative QI initiative a new national thrombectomy referral pathway was introduced with an aim that all eligible patients be referred for EVT. This initiative included maximising timely access to CT and thrombolysis. Review of local data highlighted significant deficits in these areas.A local QI team convened and a multidisciplinary approach was employed to map the existing process for CT access and time to thrombolysis decision.We describe how focused timesaving interventions such as; new emergency and radiology department 'pre-alerts', dedicated acute stroke pagers, new 'FAST' registration by clerical staff, new CT ordering codes and new 'FAST packs' (including tissue plasminogen activator, paper National Institute of Health Stroke Scale scoring tools, consent forms and EVT patient selection tools) were created and incorporated into a multidisciplinary detailed clinical stroke care pathway.We describe how we achieved our SMART aims; to reduce our door to CT time and to reduce our door to needle time to the national target of less than 30 min. A third aim was to increase the number of patients referred for EVT from our centre.This project is an accurate description of how a multidisciplinary approach combined with teamwork and effective communication can create sustainable improved patient care and is generalisable to all institutions that require timely referral to external centres for EVT.
本文描述了一家位于拥有 11.4 万居民的 431 床位医院的初级卒中中心开展的卒中质量改进（QI）项目。该卒中中心的七张卒中单元床位由三位对卒中具有亚专业兴趣的老年病学家管理，每年治疗约 170 例急性卒中。24 小时 CT 放射科服务可用。血管内血栓切除术（EVT）由位于 90-120 分钟路程的两个综合卒中中心之一的神经介入放射科进行。2018 年，作为国家协作 QI 计划的一部分，引入了新的国家 EVT 转诊途径，目的是使所有符合条件的患者都能转诊进行 EVT。该倡议包括最大限度地及时进行 CT 和溶栓治疗。对当地数据的审查突出了这些领域的显著缺陷。当地 QI 团队召开了会议，并采用多学科方法来绘制现有的 CT 访问和溶栓决策时间流程。我们描述了如何通过集中节省时间的干预措施，如：新的急诊和放射科“预警报”、专门的急性卒中寻呼机、文书人员新的“FAST”登记、新的 CT 医嘱代码和新的“FAST 包”（包括组织纤溶酶原激活物、纸质国立卫生研究院卒中量表评分工具、同意书和 EVT 患者选择工具），并将其纳入多学科详细的临床卒中护理路径。我们描述了如何实现我们的 SMART 目标；将我们的门到 CT 时间和门到针时间减少到国家目标的 30 分钟以内。第三个目标是增加我们中心转诊进行 EVT 的患者数量。这个项目准确地描述了多学科方法如何结合团队合作和有效的沟通可以创造可持续的改善患者护理，并且适用于所有需要及时转诊到外部中心进行 EVT 的机构。
