Kazama Tomohiro, Nishida Sho, Ono Kazuyuki, Meguro Yuta, Ishihara Hideaki, Kumagai Kousuke, Hayashi Shinji, Katoh Hiroshi
Department of Nursing, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan.
Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.oa.2025-0048. Epub 2025 Aug 20.
Shortening prehospital time and door-to-puncture (DTP) time are important to achieve better outcomes in patients with acute stroke. To reduce treatment delays, particularly DTP time and prehospital delays, our core hospital in the Saitama Stroke Network (SSN) implemented a series of interventions aimed at enhancing collaboration with emergency medical services (EMS) personnel and optimizing in-hospital workflows.
A revised prehospital flowchart was co-developed with the EMS to shorten on-scene time and streamline information transmission using the Cincinnati Prehospital Stroke Scale and essential clinical indicators. Simultaneously, the in-hospital stroke treatment algorithm was modified: CT was omitted, MRI was prioritized, and patients were transferred directly from the imaging suite to the operating room. Intravenous recombinant tissue-type plasminogen activator (rt-PA) was administered in the operating room. Simulation training for hospital staff was conducted bimonthly to reinforce the new protocol. We retrospectively analyzed changes in time metrics and patient volumes before (Group A, January 3, 2019, to January 3, 2020) and after (Group B, January 4, 2020, to January 4, 2021) these interventions.
Among 66 patients undergoing mechanical thrombectomy (MT), DTP time significantly decreased in Group B (p <0.001), with notable improvements in door-to-imaging and imaging-to-operating room intervals. However, prehospital times showed no significant change. The number of MT procedures increased by 54%, and SSN transports rose by 43% from Groups A to B. The rates of successful recanalization (thrombolysis in cerebral infarction score ≥2b) and rt-PA administration increased, but without significant differences.
Although we could not shorten prehospital time sufficiently, DTP time was significantly shortened by our new algorithm and simulation training, and the numbers of acute stroke patients and MT were increased significantly through collaboration with the EMS. Further collaboration with the EMS remains an important challenge going forward.
缩短院前时间和门至穿刺（DTP）时间对于急性卒中患者获得更好的治疗效果至关重要。为减少治疗延误，尤其是DTP时间和院前延误，埼玉卒中网络（SSN）的核心医院实施了一系列干预措施，旨在加强与紧急医疗服务（EMS）人员的协作并优化院内工作流程。
与EMS共同制定了修订后的院前流程图，以缩短现场时间，并使用辛辛那提院前卒中量表和基本临床指标简化信息传递。同时，修改了院内卒中治疗算法：省略CT检查，优先进行MRI检查，并将患者从影像科室直接转运至手术室。在手术室给予静脉注射重组组织型纤溶酶原激活剂（rt-PA）。每两个月对医院工作人员进行一次模拟培训，以强化新方案。我们回顾性分析了这些干预措施实施前（A组，2019年1月3日至2020年1月3日）和实施后（B组，2020年1月4日至2021年1月4日）时间指标和患者数量的变化。
在66例行机械取栓（MT）的患者中，B组的DTP时间显著缩短（p<0.001），门至影像检查和影像检查至手术室的间隔时间有显著改善。然而，院前时间没有显著变化。从A组到B组，MT手术数量增加了54%，SSN转运量增加了43%。成功再通率（脑梗死溶栓评分≥2b）和rt-PA给药率有所提高，但无显著差异。
虽然我们未能充分缩短院前时间，但通过新算法和模拟培训，DTP时间显著缩短，并且通过与EMS协作，急性卒中患者数量和MT手术数量显著增加。未来，与EMS的进一步协作仍是一项重要挑战。
