Causes of delays in management of patients with acute ischemic stroke
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Klinika Neurologii CSK MON WIM w Warszawie; kierownik: prof. dr hab. n. med. Adam Stępień
Szpitalny Oddział Ratunkowy CSK MON WIM w Warszawie; kierownik: lek. Ewa Szymczuk
p.o. kierownika Zakładu Radiologii Lekarskiej CSK MON WIM w Warszawie
Submission date: 2018-06-28
Publication date: 2018-12-10
LW 2019;97(1):19-25
Acute ischemic stroke is a life threatening emergency in which reperfusion treatment should be administered as fast as possible after stroke onset. The aim of this study was to identify delays in acute stroke management basing on a prospective register of patients hospitalized in a single care centre. Between 01/04/14 – 01/06/14 and 01/02/15 – 01/04/15we analyzed pre‑hospital an in‑hospital delays in 46 patients, including consecutive 24 subjects who received intravenous thrombolysis. Key time measurements were made before (n=24) and after (n=22) the streamline intervention which included introduction of stroke alert procedure and continuous personnel education. The main causes of delay were late stroke recognition and transfer to the hospital, late neurologic consultation at the emergency department, and waiting for the patient transfer to CT room, taking blood samples, and analysis of laboratory tests and CT scan description. On introducing the streamline measures, among patients who received thrombolysis the median door‑to‑needle (DTN) time decreased from 128 to 93 minutes, the proportion of patients with DTN <60 minutes increased from 33% to 50%. This improvement was also achieved in shorter door‑to‑CT time (48 vs 37 minutes), door‑to‑neurologic consultation (15 vs 7 minutes), door‑to‑lab sampling (24 vs 13 minutes) and CT description (40 vs 25 minutes) and laboratory results (55 vs 27 minutes). Our study proved the usefulness of continuous delay times monitoring, their analysis and streamline measures undertaken to enhance the effectiveness of management of stroke patients.
No conflicts of interest were declared.
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