Endovascular treatment outcomes using the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program

Hassan, Ameer E.; Sanchez, Christina; Johnson, Angela N.

doi:10.1177/1591019917740100

Cited by 4 publications

(4 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The most frequent interventions associated with improved workflow efficiency (SMD <0) included prenotification, direct‐to‐CT procedures, skipping multimodal CT, education and training, and monitoring and feedback, reinforcing the importance of their implementation in stroke rescue chain guidelines ( SI Table 5 ) . Although certain workflow practices such as prenotification and bedside tPA administration may be easily integrated into the AIS rescue chain, the implementation of interventions such as physician education and training may be limited by the resources of the participating stroke centre 16‐18 . Redesigning best‐practice guidelines for resource limiting settings and investigating the effect on temporal metrics and reperfusion rates is a promising area of future research.…”

Section: Discussionmentioning

confidence: 99%

In‐hospital systems interventions in acute stroke reperfusion therapy: a meta‐analysis

2021

View full text Add to dashboard Cite

Objectives The value of in‐hospital systems‐based interventions in streamlining treatment delays associated with reperfusion therapy delivery in acute ischaemic stroke (AIS), in the emergency department (ED), is poorly understood. This systematic review and meta‐analysis aimed to assess and quantify the value of in‐hospital systems‐based interventions in streamlining reperfusion therapy delivery following AIS. Material & Methods Articles from the following databases were retrieved: Medline, Embase and Cochrane Central Register of Controlled Trials. The primary endpoint was in‐hospital time metrics between the intervention and control group. The secondary endpoint included the rate of good functional outcome at 90 days. Results 393 Systems intervention studies published after 2015 were screened, and 231 full articles were then read. In total, 35 studies with 35,815 patients were included in the final systematic review and 26 studies with 7,089 patients were used in the meta‐analysis. The greatest time reductions from in‐hospital system interventions were achieved in door‐to‐needle (DTN) time (SMD: −2.696, 95% CI: −2.976, −2.416, z = 3.03, p = 0.002). Systems interventions were also associated with a statistically significant improvement in mortality (RR: 0.25, 95% CI: 0.18, 0.38), rate of symptomatic intracerebral haemorrhage (RR: 0.07, 95% CI: 0.04, 0.1) and ≤60‐minute reperfusion rates (RR: 0.63, 95% CI: 0.51, 0.79). Conclusions The use of in‐hospital workflow optimization is imperative to expedite reperfusion therapy delivery and improving patient outcomes. To reduce the morbidity and mortality of stroke globally, in‐hospital workflow guidelines should be adhered to and incorporated including the optimal elements identified in this study.

show abstract

Section: Discussionmentioning

confidence: 99%

In‐hospital systems interventions in acute stroke reperfusion therapy: a meta‐analysis

2021

View full text Add to dashboard Cite

show abstract

“…Numerous studies have concluded the benefits of physician education and feedback on improving in‐hospital procedural metrics and streamlining reperfusion therapy delivery, with a 2019 meta‐analysis concluding that physician feedback results in the greatest median reduction in treatment time (64 minutes, P = .002). Components of physician education have been incorporated into multiple trials, all of which have improved in‐hospital workflows 40,78‐80 . A 2015 network‐wide stroke improvement programme found stroke education, and regular simulation training was critical to improving median DPT by 15.5 minutes; however, this did not reach statistical significance 78 .…”

Section: In‐hospital Workflow Parametersmentioning

confidence: 99%

“…A 2015 network‐wide stroke improvement programme found stroke education, and regular simulation training was critical to improving median DPT by 15.5 minutes; however, this did not reach statistical significance 78 . A 5‐year prospective database registry concluded that the use of stroke triage education, procedural standardization and temporal feedback systems achieved significant reductions in angiography‐to‐recanalization times by 69 minutes, with significant improvements in all aspects of angiography workflow and associated clinical outcomes 80 . Reliable and transparent recording of temporal parameters in acute stroke workflow is essential in developing time metrics and quality initiatives to aim for when streamlining reperfusion therapy delivery in future.…”

Section: In‐hospital Workflow Parametersmentioning

confidence: 99%

In‐hospital acute stroke workflow in acute stroke – Systems‐based approaches

et al. 2020

View full text Add to dashboard Cite

The therapeutic goal for acute ischaemic stroke (AIS) patients is to achieve timely restoration of cerebral blood flow to the ischaemic brain tissue at risk of infarction and reduce neurological complications. 1 Current literature supports the efficacy and use of intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) in the treatment of AIS, with EVT proven to be more efficacious in patients presenting with large vessel occlusion (LVO). 2-5 When tPA and EVT are administered within their therapeutic time window of ≤4.5 and ≤6 hours, respectively, both therapies improve both recovery and clinical outcome of stroke patients. 2-6 Results from the DAWN trial have proposed extending the therapeutic time window for EVT to 24 hours due to improved efficacy and similar safety profiles. 7 Time to treatment is arguably the most important determinant of the efficacy of reperfusion

show abstract

“…The program fundamentally revolves around three interlaced principles affecting the speed and quality of care: (1) procedure workflow, (2) technologies, and (3) education. Additionally, each workflow step is recorded, using "digital objects, " or macro-enabled systems, which allow staff in the care pathway to remain connected, as stated by the American Heart Association Data Summit on the importance of integrating digital objects in modern stroke care (19,20). Prior evidence indicates the importance of these three interrelated domains (15,16,18).…”

Section: Steps-tmentioning

confidence: 99%

STEPS-T Program Improves Endovascular Treatment Outcomes of Acute Ischemic Stroke; A 6-Year Study

et al. 2020

View full text Add to dashboard Cite

Background: Early endovascular recanalization of occluded vessels in acute ischemic stroke (AIS) is a major contributor to good clinical outcome. We report the analysis of all AIS patients throughout a 6-year experience following the deployment of a quality initiative aiming at improving care, speed and maintaining quality for AIS treatment.Methods: Using a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2017, workflow/outcomes were recorded. There were no exclusion criteria. During the first year, a quality program employing "digital-object" technology, staff education, and workflow improvement was implemented to reduce time-to-treatment. Using electronic recording, workflow times were collected for onset Results: Analysis of 382 patients (aged 71.3 ± 12.9) undergoing mechanical thrombectomy for AIS (206 male and 176 female) was performed. Recanalization time was significantly reduced from 82 min in 2012 to 34 min by 2017 (IQR 52-117 min and 23-49 min), a 59% reduction (P < 0.001). Further, consistent year-over-year reductions in setup time (T A -T G ) (44% improvement) and T CT to T A times were observed. During the same period, clinical outcome significantly improved year-over-year as measured with the modified Rankin Scale 0-2 (33, 37, 38, 41, 53, and 58%).Conclusions: Significant improvements were observed following the deployment of a quality initiative enabling iterative evidence-based process improvements, thereby sustaining significant reductions in time-to-treat and improved clinical outcomes for AIS patients.

show abstract

Endovascular treatment outcomes using the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program

Cited by 4 publications

References 28 publications

In‐hospital systems interventions in acute stroke reperfusion therapy: a meta‐analysis

In‐hospital systems interventions in acute stroke reperfusion therapy: a meta‐analysis

In‐hospital acute stroke workflow in acute stroke – Systems‐based approaches

STEPS-T Program Improves Endovascular Treatment Outcomes of Acute Ischemic Stroke; A 6-Year Study

Contact Info

Product

Resources

About