Reducing the delay for carotid endarterectomy in South-East Scotland

Gaba, Kamran; Syed, Mohammad; Raza, Zahid

doi:10.1016/j.surge.2013.09.008

Cited by 8 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Only 56% of patients presented to a health professional on the day of their initial event and only 53% of patients went to the emergency department for their first health care contact. Our study complements prior research that has identified patient delays in seeking medical attention as one of the most common causes of extended timelines to CEA 12 13 In line with previous studies, our data also suggest that location of patient presentation is important, with referrals from the emergency department predicting significantly shorter wait times to CEA 1 …”

Section: Resultssupporting

confidence: 88%

“…Our study complements prior research that has identified patient delays in seeking medical attention as one of the most common causes of extended timelines to CEA. 12,13 In line with previous studies, our data also suggest that location of patient presentation is important, with referrals from the emergency department predicting significantly shorter wait times to CEA. 1,14 Delays to first health assessment contribute to delays in the completion of urgent diagnostic testing, identification of stroke etiology, and the initiation of preventive medical and surgical treatments that reduce stroke recurrence.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Fast-Track Systems Improve Timely Carotid Endarterectomy in Stroke Prevention Outpatients

Gocan

Bourgoin

Blacquiere

et al. 2016

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

Background: For optimal stroke prevention, best practices guidelines recommend carotid endarterectomy (CEA) for symptomatic patients within two weeks; however, 2013 Ontario data indicated that only 9% of eligible patients from outpatient Stroke Prevention Clinics (SPCs) achieved this target. The goal of our study was to identify modifiable system factors that could enhance the quality and timeliness of care among patients needing urgent CEA. Methods: We conducted a retrospective chart review of transient ischemic attack/stroke patients assessed in Champlain Local Health Integrated Network SPCs between 2011 and 2014 who subsequently underwent CEA. Descriptive statistics were used to define patient characteristics, timelines from symptom onset to CEA, and system factors that contributed to delays or improvements in care. Multivariate analysis was used to determine statistically significant variations between groups. Results: Seventy-five records were eligible for study inclusion. Median time from initial symptoms to CEA was 31 days, with 21.3% of patients undergoing surgery within 2 weeks. Significant delays were common in patient presentation and assessment following symptom onset, wait times for vascular imaging and neurological assessment, and time from surgical assessment to CEA completion. Rapid testing and triage, coupled with collaborative initiatives among SPC, surgical, and radiology teams were associated with significantly improved timelines. Conclusions: Success factors for rapid CEA are multifaceted, including system changes that address public awareness of stroke and 911 response, improvements in vascular imaging access, and redesign of clinical services to promote collaboration and fast-tracking of care. Implementation of performance measures to monitor and guide clinical innovations is recommended.

show abstract

Section: Resultssupporting

confidence: 88%

Section: Discussionsupporting

confidence: 90%

Fast-Track Systems Improve Timely Carotid Endarterectomy in Stroke Prevention Outpatients

Gocan

Bourgoin

Blacquiere

et al. 2016

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

show abstract

“…12e25 Most 12e21,23e25 have demonstrated that only a minority of symptomatic patients undergo CEA within the recommended 2-week period from the index event. The reasons for excess delays to CEA are multifactorial, including access to carotid imaging, long waiting times to theatre, 16,17 delays in speed of referral to vascular surgeons, 13,14,16,25 and/or delays resulting from medical comorbidities (e.g. angina pectoris, cardiac workup, etc.).…”

Section: Introductionmentioning

confidence: 99%

Editor's Choice – Delays to Surgery and Procedural Risks Following Carotid Endarterectomy in the UK National Vascular Registry

Loftus

Paraskevas

Johal

et al. 2016

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

show abstract

“…[2][3][4][5] Current American Heart Association (AHA) practice guidelines recommend that CEA should be performed as soon as possible in the first 2 weeks following a primary ischemic event, with rapidly decreasing benefits after this period. 6 As per recent Canadian and European data, only a minority of patients with symptomatic carotid stenosis are treated within the recommended time interval, [7][8][9][10][11][12] with various potential causes and solutions elicited. Therefore, the aim of this study was to assess time delays from the first cerebrovascular symptoms until the CEA procedure in a single-institution in Montreal, Quebec, following implementation of centralized care for cerebrovascular accidents.…”

mentioning

confidence: 99%