Minimising time to treatment: targeted strategies to minimise time to thrombolysis for acute ischaemic stroke

Abstract

Time to thrombolysis is a critical determinant of favourable outcomes in acute ischaemic stroke. It is not infrequent that patient outcomes are compromised due to out-of-hospital and in-hospital time delays. On the other hand, time delays could be minimised through the identification of barriers and the implementation of targeted solutions. This review outlines the different strategies in minimising treatment delays and offers recommendations. Literature search in PubMed, Medline and EBSCO Host was conducted to identify studies that are relevant to reduction of time to treatment from January 1995 to December 2012. Strategies to reduce time to thrombolysis are categorised into pre-hospital strategies, in-hospital strategies and post-treatment decision strategies. Proposed pre-hospital strategies include public education on stroke symptoms awareness, prioritising stroke by emergency medical services, increasing ease of access to medical records, pre-hospital notification, and mobile computed tomography scanning. In-hospital strategies include a streamlined code stroke system, computed tomography scanner co-location with emergency department, 24/7 availability of stroke physicians, point-of-care laboratory testing and access to expert neuroimaging interpretation. Post-decision strategies include increasing availability of intravenous thrombolysis and simplification of informed consent procurement. Time to thrombolysis delays is multifactorial. Effective reduction of time delays for acute ischaemic stroke requires the correct identification of and targeted strategies to overcome time barriers.

Paramedical risk framing during field referral of acute stroke and S–T elevation myocardial infarction patients

“…Cessation of sampling occurred once theoretical saturation14 was reached, meaning that no new information relevant to the theory was forthcoming.…”

“…Stated more optimistically, risk framing can be very helpful in terms of facilitating patient access to time-sensitive regional interventions. However, for patients with acute stroke and STEMI, this can be a difficult undertaking when we consider that it is challenging even within the controlled environment of a hospital to identify and treat these patients within strict time limits 14. Yet, paramedical referral seeks to extend these goals into the operationally diverse and uncontrolled prehospital setting, making these referrals both high-stakes and ambitious.…”

Tracking changes in glenohumeral joint position in acute post-stroke hemiparetic patients: an observational study

“…The lack of anteroinferior subluxation found in the current study may also reflect the effectiveness of current best practice guidelines which promote safe positioning and handling of the upper limb to minimise subluxation forces and potential trauma to the passive restraints of the shoulder in the acute phase (National Stroke Foundation, 2010). Additionally, in Australia in recent years, improved access to stroke units, increased awareness of and implementation of post-stroke management programs, including thrombolysis (Tai & Yan, 2013) may have also contributed to improved recovery and reducing post-stroke disability (Nazir, Petre, & Dewey, 2009;Quain et al, 2008). .…”

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

“…Brain cells die rapidly after stroke; therefore, therapeutic treatment needs to be administered early. The ‘time–outcome’ effect is highly important in stroke monitoring [ 24 , 25 , 26 , 27 ] due to the association of time delays with worse patient outcomes [ 28 , 29 , 30 ]. The most common modality for evaluation of suspected stroke patients is magnetic resonance imaging (MRI) or computed tomography (CT), which are mainly used to exclude intra-cerebral hemorrhage but have poor sensitivity for detecting acute ischemia.…”