Exclusive bed for thrombolysis. A simple measure that allows 85% of ischemic stroke patients to be treated in the first hour

Abstract

ARTICLEExclusive bed for thrombolysis. A simple measure that allows 85% of ischemic stroke patients to be treated in the first hour Leito exclusivo para trombólise. Uma medida simples que permite que 85% dos pacientes com acidente vascular cerebral sejam tratados na primeira hora Gabriella Tansini, Renata Dal-Prá Ducci, Edison Matos Nóvak, Francisco Manoel Branco Germiniani, Viviane Flumignan Zétola, Marcos Christiano Lange The outcome of patients submitted to intravenous thrombolysis (IVT) is directly related to the onset-to-needle time and one of the most important goals to reduce the time to treatment is a short door-to-needle time (DNT) 1. Current guidelines suggest that DNT should be lower than 60 minutes, but only 26% of patients achieve this goal 2 . The implementation of simple measures allowed more patients to be treated within the first hour after admission 3,4,5 . The aim of this study was to analyze whether the inclusion of an exclusive thrombolytic bed (TB) could reduce DNT in a general hospital. METHODThis was an interventional analysis study in which patients evaluated in the first period (pre-intervention; i.e. prior to the implementation of the TB) were compared with the post-intervention group and were used as historical controls. The study subjects were patients admitted with ischemic stroke who were submitted to IVT within 4.5 hours after onset of symptoms between November 2010 and June 2013. There was no formal calculation on the number of patients needed to include in the study, as the structural and AbsTrACTThe door-to-needle time is an important goal to reduce the time to treatment in intravenous thrombolysis. Objective: Analyze if the inclusion of an exclusive thrombolytic bed reduces the door-to-needle time. Method: One hundred and fifty patients admitted for neurological evaluation with ischemic stroke were separated in two groups: in the first, patients were admitted in the Emergency Room for intravenous thrombolysis (ER Group); in the second, patients were admitted in an exclusive thrombolytic bed in the general neurology ward (TB Group). Results: Sixty-eight (86.0%) patients from TB Group were treated in the first 60 minutes of arrival as compared to 48 (67.6%) in the ER Group (p = 0.011). Conclusion: The introduction of a thrombolytic bed in a general hospital setting can markedly reduce the door-to-needle time, allowing more than 85% of patients to be treated within the first hour of admission.Keywords: neurology; stroke; treatment; thrombolytic therapy. rEsuMO A redução no tempo porta-agulha é um objetivo importante para diminuir o tempo de tratamento na trombólise endovenosa. Objetivo: Analisar se a inclusão de um leito exclusivo de trombólise reduz o tempo porta-agulha. Método: Cento e cinqüenta pacientes admitidos com acidente vascular cerebral isquêmico foram separados em dois grupos: no primeiro, os pacientes foram admitidos no Pronto-Atendimento para trombólise endovenosa (Grupo PA); no segundo, os pacientes foram admitidos no leito de trombólise na enfermaria de neuro...

Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters

“…In the present study, the door-to-image time was very different in both the centers, which could be related to the patient admission flow for early stroke management. In one of the centers (Federal University of Paraná), the patients were admitted directly in the CT room, thereby significantly reducing the door-to-image time 12 . This demonstrated the importance of identifying gaps in the timeline of acute stroke care, from symptom identification by the patient and/or relatives to discharge from hospital.…”