Impact of Strengthened Collaboration with Emergency Medical Services and In-Hospital Workflow Optimization for Reducing Treatment Delays in Endovascular Thrombectomy.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.