Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening

Sablot, Denis; Gaillard, Nicolas; Colas, Chrystelle; Smadja, Philippe; Gely, Cristina; Dutray, A.; Bonnec, Jean-Marie; Jurici, Snejana; Farouil, Geoffroy; Ferraro-Allou, Adélaïde; Jantac, M.; Allou, Thibaut; Pujol, Céline; Olivier, Nadège; Laverdure, Alexandre; Fadat, Bénédicte; Mas, Julie; Dumitrana, Adrian; Garcia, Yves; Touzani, H.; Perucho, P.; Moulin, Thierry; Richard, Christian; Héroum, C.; Bouly, S.; Sagnes-Raffy, C.; Héve, D.

doi:10.1016/j.neurol.2016.12.032

Cited by 12 publications

(13 citation statements)

References 28 publications

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“…On the other hand, workflow improvements might help reducing the door-to-needle and the PSC door-in to door-out times (86 and 111 min, respectively), but with a limited impact, because very few centers using MRI have reached a door-to-needle time lower than 60 min, to date. 3 Prabhakaran et al 4 suggested that increased delays in inter-hospital transfers can reduce the likelihood of performing angiography, with a 2.5% decrease in the chance of performing intra-arterial therapy for every minute lost in transfer time. The Perpignan-GH extensive rural catchment area and the very distant CSC may explain the substantial time differences with another comparable study in an urban setting (294 vs. 240 min for symptom onset to CSC door time).…”

Section: Discussionmentioning

confidence: 99%

Thrombectomy accessibility after transfer from a primary stroke center: Analysis of a three-year prospective registry

Sablot

Gaillard

Smadja

et al. 2017

International Journal of Stroke

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Background: No comprehensive study exists about mechanical thrombectomy accessibility for patients admitted to a primary stroke center without onsite interventional neuroradiology service.Aims: To evaluate mechanical thrombectomy accessibility within 6 h after transfer from a primary stroke center to a distant (156 km apart; 1.5 h by car) comprehensive stroke center.Methods: Analysis of data collected in a three-year prospective registry on patients admitted to a primary stroke center within 4.5 h after symptom onset and selected for transfer to a comprehensive stroke center for mechanical thrombectomy. Eligible patients had confirmed proximal arterial occlusion and no large cerebral infarction on MRI images (DWI-ASPECTS 5). The rate of transfer, transfer without mechanical thrombectomy, mechanical thrombectomy, reperfusion (TICI score 2b-3), and the main relevant time measures were determined.Results: Among the 385 patients selected for intravenous thrombolysis and/or potential mechanical thrombectomy, 211 were considered as transferrable for mechanical thrombectomy. The rate of transfer was 56.4% (n ¼ 119/211), transfer without mechanical thrombectomy 56.3% (n ¼ 67/119), mechanical thrombectomy 24.6% (n ¼ 52/211), and reperfusion by MT (TICI score 2b/3) 18% (n ¼ 38/211). The relevant median times (interquartile range) were: 130 min (62) for intravenous thrombolysis start to comprehensive stroke center door, 95 minutes (39) for primary stroke center doorout to comprehensive stroke center door-in, 191 min (44) for intravenous thrombolysis start to mechanical thrombectomy puncture, 354 min (107) for symptom onset to mechanical thrombectomy puncture and 417 min (124) for symptom onset to recanalization.Conclusions: Our study suggests that transfer to a distant comprehensive stroke center is associated with reduced access to early mechanical thrombectomy in patients with acute ischemic stroke and large artery occlusion. These results could be translated to other high volume distant primary stroke center.

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Section: Discussionmentioning

confidence: 99%

Thrombectomy accessibility after transfer from a primary stroke center: Analysis of a three-year prospective registry

Sablot

Gaillard

Smadja

et al. 2017

International Journal of Stroke

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“…The QI process has been described previously [7]. Analysis of the metrics concerning consecutive tPA-treated patients during the 2014 pre-QI period revealed a median DTN time of 84 min.…”

Section: Methodsmentioning

confidence: 99%

“…Analysis of the metrics concerning consecutive tPA-treated patients during the 2014 pre-QI period revealed a median DTN time of 84 min. Therefore, in January 2015, a multidisciplinary team identified key steps (pre-admission phase, at arrival and during/after the MRI screening) that contributed to time delays (see [7] for the full list), and defined workflow improvements with special emphasis on reducing DTN time. Specific interventions were introduced with the aim of reducing DTN times by using only the existing resources (online suppl.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, guidelines [5] have been promoted to reduce the time required for AIS evaluation and treatment, with a target benchmark door-to-needle (DTN) time for tPA administration below 60 min (class I; level of evidence A). To date, very few studies have reported a consistent reduction of the 60-min DTN benchmark with MRI-based screening protocols [6, 7], and none earlier than 45 min as described for centres using CT-based screening [8-15]. In a previous work [7], we showed that 1 year after the implementation of a focused quality improvement (QI) programme to reduce the time between admission and treatment when using multimodal MRI screening, IV tPA could be administered to patients within 60 min after admission.…”

Section: Introductionmentioning

confidence: 99%

“…To date, very few studies have reported a consistent reduction of the 60-min DTN benchmark with MRI-based screening protocols [6, 7], and none earlier than 45 min as described for centres using CT-based screening [8-15]. In a previous work [7], we showed that 1 year after the implementation of a focused quality improvement (QI) programme to reduce the time between admission and treatment when using multimodal MRI screening, IV tPA could be administered to patients within 60 min after admission. Here, we assessed whether 2 years of QI programme resulted in reducing the DTN time below 45 min.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Target Door-to-Needle Time for Tissue Plasminogen Activator Treatment with Magnetic Resonance Imaging Screening Can Be Reduced to 45 min

Sablot¹,

Ion²,

Khlifa³

et al. 2018

Cerebrovasc Dis

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Objective: The purpose of this study was to demonstrate that the median door-to-needle (DTN) time for intravenous tissue plasminogen activator (tPA) treatment can be reduced to 45 min in a primary stroke centre with MRI-based screening for acute ischaemic stroke (AIS). Methods: From February 2015 to February 2017, the stroke unit of Perpignan general hospital, France, implemented a quality-improvement (QI) process. During this period, patients who received tPA within 4.5 h after AIS onset were included in the QI cohort. Their clinical characteristics and timing metrics were compared each semester and also with those of 135 consecutive patients with AIS treated by tPA during the 1-year pre-QI period (pre-QI cohort). Results: In the QI cohort, 274 patients (92.5%) underwent MRI screening. While the demographic and baseline characteristics were not significantly different between cohorts, the median DTN time was significantly lower in the QI than in the pre-QI cohort (52 vs. 84 min; p < 0.00001). Within the QI cohort, the median DTN time for each semester decreased from 65 to 44 min (p < 0.00001) and the proportion of treated patients with a DTN time ≤45 min increased from 25 to 58.9% (p < 0.0001). Overall, DTN time improvement was associated with a better outcome at 3 months (patients with a modified Rankin Scale score between 0 and 2: 61.8% in the QI vs. 39.3% in the pre-QI cohort; p < 0.0001). Conclusions: A QI process can reduce the DTN within 45 min with MRI as a screening tool.

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Usefulness of a single-parameter tool for the prediction of large vessel occlusion in acute stroke

et al. 2020

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Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with MRI screening

Cited by 12 publications

References 28 publications

Thrombectomy accessibility after transfer from a primary stroke center: Analysis of a three-year prospective registry

Thrombectomy accessibility after transfer from a primary stroke center: Analysis of a three-year prospective registry

Target Door-to-Needle Time for Tissue Plasminogen Activator Treatment with Magnetic Resonance Imaging Screening Can Be Reduced to 45 min

Usefulness of a single-parameter tool for the prediction of large vessel occlusion in acute stroke

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