Improving Acute In-Hospital Stroke Care by Reorganization of an In-Hospital Stroke Code Protocol

Kawano, Hiroyuki; Ebisawa, Shiori; Ayano, Mizuki; Kono, Yuko; Saito, Mitsuhiro; Johno, Takashi; Maruoka, Hibiku; Nakada, Ryoji; Yamashita, Hitomi; Nakanishi, Kaoru; Honda, Yuko; Amano, Takahiro; Unno, Yoshiko; Komatsu, Yuka; Ogawa, Yuriko; Shiokawa, Yoshiaki; Hirano, Teruyuki

doi:10.1016/j.jstrokecerebrovasdis.2020.105433

Cited by 11 publications

(17 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…In-hospital use of telestroke is also an option to reduce delays and increase the number of patients receiving thrombolysis [ 100 ]. Some studies demonstrated that a protocol containing coordinated actions [ 62 , 78 , 80 , 87 , 88 ], for instance hospital pre-notification by emergency services, direct transfer of patients to the IR immediately after rapid neurological assessment in the emergency room, alteplase preparation soon after first images, rapid interpretation of brain tomography followed by administration of thrombolysis while in the brain CT marked reduced delays and was associated with better outcomes [ 83 , 101 , 102 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Botelho

Rios

Fidalgo

et al. 2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…In a tertiary care hospital in Japan, the development and implementation of a stroke code protocol and educational workshops resulted in decreased time from stroke recognition to neurologist assessment (91-35 minutes; P=0.002) and to neuroimaging (123-74 minutes; P=0.013), but no changes in thrombolysis or endovascular therapy were observed. 13 Acute Hospital Care QI Several studies described in-hospital care QI initiatives including in Nova Scotia (Canada), 14 Australia, 15 and in single institutions in Denmark, 16 and East Kent (United Kingdom). 17 The studies varied in terms of the QI intervention; some were multifaceted, 14 whereas others focused on a single QI strategy (eg, PDSA cycles, 16,17 external facilitation 15 ).…”

Section: Ctmentioning

confidence: 99%

Section: Prehospital Care Qimentioning

confidence: 99%

Advances in Stroke: Quality Improvement

Bravata

Purvis

Kilkenny

2022

Stroke

View full text Add to dashboard Cite

“…The American Heart Association recommends organized in-hospital protocols, acute stroke teams, multicomponent hospital quality initiatives, and stroke systems with prompt door-to-imaging times 5. Nurse-driven in-hospital code stroke and reorganized in-hospital stroke (IHS) protocols improve stroke recognition and treatment 6,7. This study aimed to understand whether reimplementation of code stroke as a bundle versus the current code stroke process, over 3 months, improved early recognition and treatment of inpatient strokes among the adult inpatient population.…”

mentioning

confidence: 99%

Bundled Approach to Improve Inpatient Stroke Recognition and Time to Treatment

Drollinger

Prasun

2022

Journal of Neuroscience Nursing

View full text Add to dashboard Cite

BACKGROUND: Early recognition of inpatient stroke is critical in reducing poor outcomes. A gap in knowledge and recognition of stroke by nursing staff was observed; protocols did not incorporate the Balance, Eyes, Face, Arms, Speech, and Time (BE-FAST) symptom mnemonic, and code stroke documentation was frequently incomplete. PURPOSE: This initiative aimed to improve timely recognition, evidence-based treatment, and nursing documentation of stroke-related symptoms. METHODS: This quality improvement initiative implemented an inpatient nurse-driven code stroke bundle. A pre-post prospective intervention design was implemented over 3 months. Code stroke bundle components included an evidence-based protocol, algorithm, visual aids, and education. Nursing communication and documentation used the BE-FAST mnemonic in a Situation, Background, Assessment, Recommendation format. RESULTS: Nursing stroke knowledge improved 8% (88% vs 96%, P < .001); stroke response times improved 15 minutes (25.9 vs 11 minutes, P = .383), although not significant; the code stroke documentation completion rate was increased 48.1% (0 [0%] vs 13 [48.1%], P < .001); and improved utilization of the BE-FAST tool with Situation, Background, Assessment, Recommendation communication (0 [0%] vs 20 [47.6%], P = < .001) was observed. The code stroke cancelation rate slightly worsened (10 [26.3%] vs 14 [26.9%], P = .949), code stroke notifications for altered mental status improved (15 [39.5%] vs 8 [15.7%], P = .015), and the stroke mimic rate improved (27 [71.1%] vs 35 [67.3%], P = .708). CONCLUSION: Nurses provide hospital patient care continuously and are in a key position to intervene when patients present changes in symptoms. Through education and creating an evidence-based protocol, nurses can impact patient outcomes in early recognition and activation of the code stroke system. Further studies are warranted to refine strategies leading to continued improvement in early stroke identification.

show abstract

Improving Acute In-Hospital Stroke Care by Reorganization of an In-Hospital Stroke Code Protocol

Cited by 11 publications

References 21 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

Advances in Stroke: Quality Improvement

Bundled Approach to Improve Inpatient Stroke Recognition and Time to Treatment

Contact Info

Product

Resources

About