An in-hospital stroke system to optimize emergency management of acute ischemic stroke by reducing door-to-needle time

Yixiong Zhang; Yimin Zhu; Tao Jiang; Jun Liu; Xianyi Tang; Weichen Yi

doi:10.1016/j.ajem.2023.04.008

An in-hospital stroke system to optimize emergency management of acute ischemic stroke by reducing door-to-needle time

Am J Emerg Med. 2023 Jul:69:147-153. doi: 10.1016/j.ajem.2023.04.008. Epub 2023 Apr 11.

Authors

Yixiong Zhang¹, Yimin Zhu², Tao Jiang¹, Jun Liu³, Xianyi Tang⁴, Weichen Yi¹

Affiliations

¹ The First People's Hospital of Huaihua, Huaihua City, China.
² Poisoning Research Laboratory, Institue of Emergency Medicine, Hunan Provincial People's Hospital, The First Affiliate Hospital of Hunan Normal University, Changsha City, China. Electronic address: zhuyimin198@126.com.
³ Changsha Central Hospital, Changsha City, China. Electronic address: liujun3315@163.com.
⁴ Poisoning Research Laboratory, Institue of Emergency Medicine, Hunan Provincial People's Hospital, The First Affiliate Hospital of Hunan Normal University, Changsha City, China.

PMID: 37119700
DOI: 10.1016/j.ajem.2023.04.008

Abstract

Background: Door-to-needle time (DNT) is a critical consideration in emergency management of acute ischemic stroke (AIS). Deficiencies in the widely applied standard hospital workflow process, based on international guidelines, impede rapid treatment of AIS patients. We developed an in-hospital stroke system to reduce DNT and optimize hospitals' emergency procedures.

Objectives: To investigate the effect of the in-hospital stroke system on the hospital workflow for AIS patients.

Methods: We performed a retrospective study on AIS patients between June 2017 and December 2021. AIS cases were assigned to a pre-intervention group (before the in-hospital stroke system was established) and a post-intervention group (after the system's establishment). We compared the two groups' demographic features, clinical characteristics, treatments and outcomes, and time metrics data.

Results: We analyzed 1031 cases, comprising 474 and 557 cases in the pre-intervention and post-intervention groups, respectively. Baseline data were similar for both groups. Significantly more patients in the post-intervention group (41.11%) were treated with intravenous thrombolysis (IVT) or endovascular therapy (ET) compared with those in the pre-intervention group (8.65%) (p < 0.001). DNT was markedly improved (decreasing from 118 (80.5-137) min to 26 (21-38) min among patients in the post-intervention group treated with IVT or bridging ET. Consequently, a much higher proportion of these patients (92.64%) received IVT within 60 min compared with those in the pre-intervention group (17.39%) (p < 0.001). Consequently, their hospital stays were shorter (8 [6-11] days vs. 10 [8-12] days for the pre-intervention group; p < 0.001), and they showed improved National Institutes of Health Stroke Scale (NIHSS) scores at discharge (-2 [-5-0] vs. -1 [-2-0], p < 0.001).

Conclusion: DNT was significantly reduced following implementation of the in-hospital stroke system, which contributed to improved patient outcomes measured by the length of hospital stay and NIHSS scores.

Keywords: Acute ischemic stroke; Door-to-needle time; Emergency management; Stroke information need; Stroke unit.

MeSH terms

Brain Ischemia* / drug therapy
Fibrinolytic Agents / therapeutic use
Hospitals
Humans
Ischemic Stroke* / drug therapy
Retrospective Studies
Stroke* / drug therapy
Thrombolytic Therapy / methods
Time-to-Treatment
Treatment Outcome

Substances

Fibrinolytic Agents