University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Medical College of Wisconsin, Milwaukee, Wisconsin.
S D Med. 2022 Feb;75(2):72-75.
Optimization of time metrics in the management of acute stroke is a priority. Nurses with special training in stroke management may contribute to enhanced delivery of care. This study analyzes the effects of initiating a nurse-led stroke triage program at a regional stroke center on time metrics of acute stroke.
In retrospective review, stroke metrics 25 months prior to the start of the triage program and 23 months after the start of the program were analyzed, including time from arrival to: emergency department assessment, neurologist assessment, head computed tomography (CT) scan, start of tissue plasminogen activator (tPA) administration, and puncture for mechanical thrombectomy.
The study included 1,019 patients presenting with symptoms of acute stroke. Significant decrease was found between means for the time measures of arrival to emergency department (ED) physician assessment (pre-program: 6.2 minutes, post-program: 5.7 minutes, p= 0.0036), and CT start (pre-program: 21.3 minutes, post-program: 19.8 minutes, p= 0.0001). Time from arrival to ED physician assessment and CT start showed an increase in the proportion of cases meeting goal times: ED physician assessment increased from 82 percent to 84.4 percent of cases meeting the goal time (p= 0.3543), and CT start increased from 55.3 percent to 63.2 percent (p= 0.0481) of cases meeting the goal time. Significant increase was found between means for time from arrival to neurologist assessment (pre-program: 11.6 minutes, post-program: 17.1 minutes, p= 0.0015), and the proportion of cases meeting the goal time for arrival to neurologist assessment decreased (88.8 percent pre-program, 75.8 percent post-program). No significant differences were found for times from arrival to tPA administration and mechanical thrombectomy, or between Modified Rankin Scores (mRS) at discharge.
Certain time-sensitive metrics of acute stroke care were improved after implementation of the stroke nurse triage program, particularly those related to immediate patient assessment within the ED. Time metrics related to the direct administration of stroke therapies were unaffected, indicating the need for recognition of additional factors affecting timely stroke management. Incorporating specially trained stroke nurses in acute stroke management may be an important component in efforts to improve time metrics of acute stroke.
优化急性脑卒中管理的时间指标是当务之急。接受过脑卒中管理专业培训的护士可能有助于提高护理水平。本研究分析了在区域脑卒中中心启动护士主导的脑卒中分诊计划对急性脑卒中时间指标的影响。
在回顾性研究中，分析了分诊计划启动前 25 个月和启动后 23 个月的脑卒中指标，包括从到达医院到：急诊科评估、神经科医生评估、头部计算机断层扫描（CT）检查、开始使用组织型纤溶酶原激活剂（tPA）治疗以及机械血栓切除术穿刺的时间。
本研究纳入了 1019 例出现急性脑卒中症状的患者。研究发现，到达急诊科医生评估的时间（启动前：6.2 分钟，启动后：5.7 分钟，p=0.0036）和 CT 扫描开始时间（启动前：21.3 分钟，启动后：19.8 分钟，p=0.0001）的均值之间存在显著差异。到达急诊科医生评估和 CT 扫描开始的时间，满足目标时间的病例比例有所增加：到达急诊科医生评估的目标时间的病例比例从 82%增加到 84.4%（p=0.3543），CT 扫描开始的目标时间的病例比例从 55.3%增加到 63.2%（p=0.0481）。到达神经科医生评估的时间均值（启动前：11.6 分钟，启动后：17.1 分钟，p=0.0015）之间存在显著差异，且满足神经科医生评估目标时间的病例比例下降（启动前：88.8%，启动后：75.8%）。到达 tPA 治疗和机械取栓治疗的时间以及出院时的改良 Rankin 评分（mRS）之间无显著差异。
实施脑卒中护士分诊计划后，急性脑卒中护理的某些时间敏感指标得到改善，特别是急诊科内患者即刻评估方面。与直接给予脑卒中治疗相关的时间指标没有变化，这表明需要认识到影响及时脑卒中管理的其他因素。在急性脑卒中管理中纳入接受过专门培训的脑卒中护士可能是改善急性脑卒中时间指标的重要组成部分。
