Identificación de los factores que influyen en el retraso intrahospitalario del inicio de trombólisis intravenosa en el ictus agudo en un hospital terciario

Mohedano, A.M. Iglesias; Pastor, A. García; Arratibel, A. García; García, P. Sobrino; Otero, Francisco Javier Sanjiao; Delgado, Francisco; Rubio, Rafael; González, A. Muñoz; Alén, P. Vázquez; Bullido, Y. Fernández; Osorio, José; Núñez, A. Gil

doi:10.1016/j.nrl.2014.12.004

Cited by 17 publications

(5 citation statements)

References 28 publications

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“…We found 49 studies containing information on intra-hospitalar organizational factors associated with delays or access to ART ( Appendix A - Table A3 ). Training emergency room professionals [ 61 , 62 , 63 , 64 , 65 , 66 ], promotion of specific stroke code protocols [ 30 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ], direct transfer from ambulance to the imaging room [ 86 , 87 , 88 , 89 , 90 , 91 , 92 ], strategic location of the imaging room (IR) [ 93 ], and routine administration of thrombolysis in the IR, were considered effective strategies to reduce thrombolysis delay [ 68 , 69 , 85 , 86 , 87 , 88 , 89 , 94 , 95 ]. In places where the physician, usually a neurologist, responsible for thrombolysis, is on-call, pre-notification of possible stroke before imaging also reduced delays [ 37 , 68 , …”

Section: Resultsmentioning

confidence: 99%

“…Use of ambulance significantly reduced pre and intra-hospital delays, especially if pre-notification is made to the hospital allowing the hospital teams to check the patient’s previous clinical notes and the put everything involved in the chain of care in “preparedness mode” including the availability of the imaging room [ 12 , 15 , 16 , 17 , 20 , 22 , 23 , 37 , 39 , 40 , 44 , 48 , 51 , 61 , 92 , 96 , 97 , 98 , 110 , 111 , 112 , 113 ]. For time-dependent treatment, such as the ART, implementation of prehospital [ 51 , 61 , 75 , 98 , 107 ] and intrahospital [ 48 , 51 , 59 , 67 , 68 , 70 , 71 , 72 , 74 , 76 , 77 , 79 , 84 , 86 , 89 , 90 , 91 , 92 , 108 , 109 , 111 , 114 , 115 , 116 , 117 ] protocols are fundamental. Although methodology and pro...…”

Section: Discussionmentioning

confidence: 99%

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Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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Background: After onset of acute ischemic stroke (AIS), there is a limited time window for delivering acute reperfusion therapies (ART) aiming to restore normal brain circulation. Despite its unequivocal benefits, the proportion of AIS patients receiving both types of ART, thrombolysis and thrombectomy, remains very low. The organization of a stroke care pathway is one of the main factors that determine timely access to ART. The knowledge on organizational factors influencing access to ART is sparce. Hence, we sought to systematize the existing data on the type and frequency of pre-hospital and in-hospital organizational factors that determine timely access to ART in patients with AIS. Methodology: Literature review on the frequency and type of organizational factors that determine access to ART after AIS. Pubmed and Scopus databases were the primary source of data. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale. Results: A total of 128 studies were included. The main pre-hospital factors associated with delay or access to ART were medical emergency activation practices, pre-notification routines, ambulance use and existence of local/regional-specific strategies to mitigate the impact of geographic distance between patient locations and Stroke Unit (SU). The most common intra-hospital factors studied were specific location of SU and brain imaging room within the hospital, and the existence and promotion of specific stroke treatment protocols. Most frequent factors associated with increased access ART were periodic public education, promotion of hospital pre-notification and specific pre- and intra-hospital stroke pathways. In specific urban areas, mobile stroke units were found to be valid options to increase timely access to ART. Conclusions: Implementation of different organizational factors and strategies can reduce time delays and increase the number of AIS patients receiving ART, with most of them being replicable in any context, and some in only very specific contexts.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

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“…En los 1.743 pacientes incluidos en el código ictus, la media de edad fue de 72,83 ± 13,1 años, y se aprecian diferencias significativas respecto a otros estudios referidos a Madrid (69,24 ± 12,88 años) [11] o Murcia (68,51 años; IC 95%: 67,08-69,95 años) [12].…”

Section: Discussionunclassified

“…Al comparar este resultado con el descrito en la bibliografía, se aprecia una variabilidad amplia en los formatos de recogida y en los tiempos de respuesta encontrados, como es esperable dadas las diferentes características territoriales y densidades. En el Hospital Clínico Universitario Virgen de la Arrixaca, el 36,3% se trata en los primeros 60 minutos, mientras que en Madrid se ha publicado una mediana de 84 minutos (rango intercuartílico: 60-120 min) [11].…”

Section: Discussionunclassified

Casuística de códigos ictus atendidos por 061 ARAGÓN en el período 2010-2016. Factores que influyen en los tiempos de respuesta y de acceso a la fibrinólisis

Ml¹,

Marta-Enguita²,

Marta-Moreno³

et al. 2019

RevNeurol

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Objetivo. Estudiar los tiempos de respuesta en la atención al código ictus por unidades asistenciales del 061 ARAGÓN, analizando los factores implicados y su relación con el acceso al tratamiento fibrinolítico en la fase hiperaguda. Pacientes y métodos. Estudio descriptivo transversal sobre la asistencia extrahospitalaria a partir del registro de casos atendidos por unidades asistenciales del 061 ARAGÓN a pacientes con código ictus durante el período 2010-2016. Resultados. Se recogieron 1.743 pacientes con código ictus (54,6%, varones), con una edad media de 72,83 ± 13,1 años. El número de ictus atendidos en 2015 y 2016 (372 y 366, respectivamente) fue mayor que la media de 201 ictus anuales en el resto de los años. El 27,2% de los pacientes fueron atendidos entre las 08:00 y las 11:59 h, intervalo horario con mayor frecuentación. Respecto al tiempo que se tardó en atender al paciente, la media fue de 71,93 ± 33,64 minutos, con mayor tiempo de respuesta en Teruel. Cuando se analizó la influencia del intervalo horario sobre el porcentaje de casos tratados con fibrinólisis, se observó una mayor tasa de fibrinólisis cuando se activó entre las 12:00 y las 15:59 h (28,1%). Conclusión. En el 55,3% de los pacientes, el tiempo de respuesta del 061 fue mayor de 60 minutos, pero este tiempo no se vio condicionado por la hora de activación. Sin embargo, sí había diferencias en el porcentaje de casos de fibrinólisis en los diferentes intervalos horarios, lo que sugiere que factores distintos al tiempo de respuesta del 061 influyen en la indicación del tratamiento fibrinolítico. Palabras clave. Atención extrahospitalaria. Código ictus. Fibrinólisis. Ictus isquémico. Stroke mimics. Tiempo de respuesta.

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“…Coordinating timely imaging is thus crucial to reduction in DTN times. A single, all-points stroke alert has contributed to reduced DTN times and increased tPA administration in singlecenter studies [7][8][9]. Notwithstanding such improvements, continued and multifactorial delays preclude successful therapy within the treatment window.…”

Section: Introductionmentioning

confidence: 99%

Utilization of Workflow Process Maps to Analyze Gaps in Critical Event Notification at a Large, Urban Hospital

et al. 2015

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Stroke care is a time-sensitive workflow involving multiple specialties acting in unison, often relying on one-way paging systems to alert care providers. The goal of this study was to map and quantitatively evaluate such a system and address communication gaps with system improvements. A workflow process map of the stroke notification system at a large, urban hospital was created via observation and interviews with hospital staff. We recorded pager communication regarding 45 patients in the emergency department (ED), neuroradiology reading room (NRR), and a clinician residence (CR), categorizing transmissions as successful or unsuccessful (dropped or unintelligible). Data analysis and consultation with information technology staff and the vendor informed a quality intervention-replacing one paging antenna and adding another. Data from a 1-month post-intervention period was collected. Error rates before and after were compared using a chi-squared test. Seventy-five pages regarding 45 patients were recorded pre-intervention; 88 pages regarding 86 patients were recorded post-intervention. Initial transmission error rates in the ED, NRR, and CR were 40.0, 22.7, and 12.0 %. Post-intervention, error rates were 5.1, 18.8, and 1.1 %, a statistically significant improvement in the ED (p < 0.0001) and CR (p = 0.004) but not NRR (p = 0.208). This intervention resulted in measureable improvement in pager communication to the ED and CR. While results in the NRR were not significant, this intervention bolsters the utility of workflow process maps. The workflow process map effectively defined communication failure parameters, allowing for systematic testing and intervention to improve communication in essential clinical locations.

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Identificación de los factores que influyen en el retraso intrahospitalario del inicio de trombólisis intravenosa en el ictus agudo en un hospital terciario

Abstract: This study enabled us to identify CTA and the «3-hour effect» as the 2 factors that delay IVT in our hospital. In contrast, activating code stroke clearly reduces DTN. This information will be useful in our future attempts to reduce door-to-needle times.

Cited by 17 publications

References 28 publications

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Organizational Factors Determining Access to Reperfusion Therapies in Ischemic Stroke-Systematic Literature Review

Casuística de códigos ictus atendidos por 061 ARAGÓN en el período 2010-2016. Factores que influyen en los tiempos de respuesta y de acceso a la fibrinólisis

Utilization of Workflow Process Maps to Analyze Gaps in Critical Event Notification at a Large, Urban Hospital

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