Li Baiyu, Zhang Zhufeng, Li Keye, Zhao Lingdie, Niu Rong
Department of Emergency Medicine, Zhejiang Hospital, Hangzhou, Zhejiang Province, China.
Int J Nurs Sci. 2024 Oct 11;11(5):521-527. doi: 10.1016/j.ijnss.2024.10.004. eCollection 2024 Nov.
Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes. This study investigated whether optimizing intravenous thrombolytic (IVT) therapy strategies for stroke could reduce treatment delays.
To reduce delays in IVT therapy for ischemic stroke, a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou, Zhejiang Province, from June 2021 to August 2023, which included developing a timeline process management system, forming a nurse-led stroke process management team, providing homogeneous training, standardizing the IVT therapy process for ischemic stroke, and introducing an incentive policy. During the pre- (from June 2021 to February 2022, group A) and post- (from March to November 2022, group B1; from December 2022 to August 2023, group B2 [implementation of an additional incentive policy]) of the implementation the strategy, the door-to-computed tomographic angiography (CTA) time (DCT), CTA time, neurology consultation to consent for IVT, CTA-to-needle time (CNT), and door-to-needle time (DNT), the percentage of people who underwent CTA within 20 min, 15 min, and 10 min and DNT within 60 min, 45 min, and 30 min were collected and compared.
Following the implementation of the standardized IVT process management strategy for stroke, the DNT for group B1 and group B2 were 30 (24, 44) min and 31 (24, 41) min, respectively, both significantly lower than the 46 (38, 58) min in group A ( < 0.001); the median DCT were both 13 min in group B1 and B2 lower than 17min in group A ( < 0.001); the median CTA were 12 min in Group B1 and 9 min in Group B2 lower than 14 min in group A ( < 0.001); similar results were observed during the neurology consultation to obtain consent for IVT and CNT. Compared with group A, the proportion of DCT ≤ 20 min, 15 min, and 10 min was higher in groups B1 and B2 ( < 0.05), and the same result was observed at DNT ≤60 min, 45 min, and 30 min ( < 0.05). However, the additional incentive policy did not significantly differ between Group B2 and Group B1.
Optimizing IVT therapy for ischemic stroke is a feasible approach to limit the DNT to 30 min in ischemic stroke, significantly reducing delays within the therapeutic window and increasing the number of patients meeting target time segments. Additionally, generating a timeline for the IVT therapy process by scanning positioning quick response codes was a significant breakthrough in achieving the informatization of IVT quality management for stroke.
在治疗窗内对缺血性卒中进行早期溶栓治疗可改善临床结局。本研究调查了优化卒中静脉溶栓（IVT）治疗策略是否能减少治疗延迟。
为减少缺血性卒中IVT治疗的延迟，2021年6月至2023年8月在浙江省杭州市的一家三级医院实施了一系列质量改进措施，包括制定时间线流程管理系统、组建以护士为主导的卒中流程管理团队、提供同质化培训、规范缺血性卒中的IVT治疗流程以及引入激励政策。在实施该策略前（2021年6月至2022年2月，A组）和实施后（2022年3月至11月，B1组；2022年12月至2023年8月，B2组[实施额外激励政策]），收集并比较了从入院到计算机断层血管造影（CTA）时间（DCT）、CTA时间、神经内科会诊至同意IVT的时间、CTA至穿刺时间（CNT）以及入院至穿刺时间（DNT），在20分钟、15分钟和10分钟内接受CTA检查的人群百分比以及在60分钟、45分钟和30分钟内DNT的人群百分比。
实施标准化的卒中IVT流程管理策略后，B1组和B2组的DNT分别为30（24，44）分钟和31（24，41）分钟，均显著低于A组的46（38，58）分钟（<0.001）；B1组和B2组的DCT中位数均为13分钟，低于A组的17分钟（<0.001）；B1组的CTA中位数为12分钟，B2组为9分钟，低于A组的14分钟（<0.001）；在神经内科会诊以获得IVT同意和CNT方面也观察到类似结果。与A组相比，B1组和B2组中DCT≤20分钟、15分钟和10分钟的比例更高（<0.05），在DNT≤60分钟、45分钟和30分钟时也观察到相同结果（<0.05）。然而，B2组与B1组之间的额外激励政策没有显著差异。
优化缺血性卒中的IVT治疗是将缺血性卒中的DNT限制在30分钟内的可行方法，可显著减少治疗窗内的延迟，并增加达到目标时间段的患者数量。此外，通过扫描定位二维码生成IVT治疗流程的时间线是实现卒中IVT质量管理信息化的一项重大突破。
