Journal of Stroke (May 2017)

Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis

  • Sang-Beom Jeon,
  • Seung Mok Ryoo,
  • Deok Hee Lee,
  • Sun U. Kwon,
  • Seongsoo Jang,
  • Eun-Jae Lee,
  • Sang Hun Lee,
  • Jung Hee Han,
  • Mi Jeong Yoon,
  • Soo Jeong,
  • Young-Uk Cho,
  • Sungyang Jo,
  • Seung-Bok Lim,
  • Joong-Goo Kim,
  • Han-Bin Lee,
  • Seung Chai Jung,
  • Kye Won Park,
  • Min-Hwan Lee,
  • Dong-Wha Kang,
  • Dae Chul Suh,
  • Jong S. Kim

DOI
https://doi.org/10.5853/jos.2016.01802
Journal volume & issue
Vol. 19, no. 2
pp. 196 – 204

Abstract

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Background and Purpose Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. Methods We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. Results A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). Conclusions SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.

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