Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis.
- Author:
Sang Beom JEON
1
;
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
Author Information
- Publication Type:Original Article
- Keywords: Cerebral infarction; Thrombolytic therapy; Tissue plasminogen activator
- MeSH: Ambulances; Cerebral Infarction; Humans; Intracranial Hemorrhages; Mortality; Stroke*; Thrombectomy; Thrombolytic Therapy; Tissue Plasminogen Activator
- From:Journal of Stroke 2017;19(2):196-204
- CountryRepublic of Korea
- Language:English
- Abstract: 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.
