Grönroos Markku, Hällberg Ville, Helminen Mika, Koivistoinen Teemu, Palomäki Ari
Kanta-Häme Central Hospital, Emergency Department, Kanta-Häme Welfare District, Hämeenlinna, Finland.
Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.
BMJ Neurol Open. 2024 Nov 12;6(2):e000687. doi: 10.1136/bmjno-2024-000687. eCollection 2024.
Thrombolysis should be administered as soon as possible to suitable patients with acute ischaemic stroke. We introduced a new protocol for patients who had a stroke to achieve reduced door-to-needle times for the best possible outcome. Since then, we have closely monitored each patient who had a stroke. Our goal was to assess whether statistical process control charts could be useful in detecting deviations in door-to-needle times when using four well-known rules applied by Western Electric (WE rules 1-4).
We analysed retrospectively door-to-needle times of together 200 acute ischaemic stroke patients before and after the implementation of our new stroke protocol. In addition, 25 patients at the time of reorganisation (transition period) were analysed. Statistical process control chart rules WE 1-WE 4 were applied to detect door-to-needle deviations and to monitor process uniformity.
Before the implementation of the protocol, median door-to-needle time was 53 min and after the implementation 20 min. Statistical process control chart rules were triggered only once in 100 patients before the reorganisation but seven times in 25 patients during the transition period. None of the rules WE 1-4 were activated after the reorganisation, indicating the stability of the reorganised acute ischaemic stroke process.
The use of statistical process control charts demonstrated a significant reduction in door-to-needle times during the reorganisation. Further, it showed that the acute ischaemic stroke process with a 20 min door-to-needle time is very stable.
对于急性缺血性脑卒中的合适患者，应尽快进行溶栓治疗。我们为脑卒中患者引入了一种新方案，以缩短从入院到开始溶栓的时间，从而实现最佳治疗效果。自那时起，我们对每一位脑卒中患者进行了密切监测。我们的目标是评估统计过程控制图在使用西部电气公司的四条著名规则（WE规则1 - 4）来检测从入院到开始溶栓时间的偏差时是否有用。
我们回顾性分析了在新的脑卒中方案实施前后共200例急性缺血性脑卒中患者的从入院到开始溶栓的时间。此外，还分析了在重组时（过渡期）的25例患者。应用统计过程控制图规则WE 1 - WE 4来检测从入院到开始溶栓的偏差，并监测过程的一致性。
在方案实施前，从入院到开始溶栓的中位时间为53分钟，实施后为20分钟。在重组前，100例患者中统计过程控制图规则仅触发过一次，但在过渡期的25例患者中触发了七次。重组后，WE 1 - 4规则均未激活，这表明重组后的急性缺血性脑卒中治疗过程具有稳定性。
统计过程控制图的使用表明在重组期间从入院到开始溶栓的时间显著缩短。此外，它还表明从入院到开始溶栓时间为20分钟的急性缺血性脑卒中治疗过程非常稳定。
