Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

Abstract

Background: The clinical benefit from endovascular therapy (EVT) for patients with acute ischemic stroke is time-dependent. We tested the hypothesis that team prenotification results in faster procedure times prior to initiation of EVT.Methods: We analyzed data from our prospective database (01/2016–02/2018) including all patients with acute ischemic stroke who were evaluated for EVT at our comprehensive stroke center. We established a standardized algorithm (EVT-Call) in 06/2017 to prenotify team members (interventional neuroradiologist, neurologist, anesthesiologist, CT and angiography technicians) about patient transfer from remote hospitals for evaluation of EVT, and team members were present in the emergency department at the expected patient arrival time. We calculated door-to-image, image-to-groin and door-to-groin times for patients who were transferred to our center for evaluation of EVT, and analyzed changes before (–EVT-Call) and after (+EVT-Call) implementation of the EVT-Call.Results: Among 494 patients in our database, 328 patients were transferred from remote hospitals for evaluation of EVT (208 -EVT-Call and 120 +EVT-Call, median [IQR] age 75 years [65–81], NIHSS score 17 [12–22], 49.1% female). Of these, 177 patients (54%) underwent EVT after repeated imaging at our center (111/208 [53%) -EVT-Call, 66/120 [55%] +EVT-Call). Median (IQR) door-to-image time (18 min [14–22] vs. 10 min [7–13]; p < 0.001), image-to-groin time (54 min [43.5–69.25] vs. 47 min [38.3–58.75]; p = 0.042) and door-to-groin time (74 min [58–86.5] vs. 60 min [49.3–71]; p < 0.001) were reduced after implementation of the EVT-Call.Conclusions: Team prenotification results in faster patient assessment and initiation of EVT in patients with acute ischemic stroke. Its impact on functional outcome needs to be determined.

Optimizing Time Management for Drip-and-Ship Stroke Patients Qualifying for Endovascular Therapy—A Single-Network Study

“…The advantages of the prenotification, announcing the approximate arrival of the patient at the CSC to optimize workflow through the direct availability of stroke neurologists, neuro-interventionalists and anesthesiologists, as well as the CT scanner, for the management in the CSC have been discussed in detail in a previous study [ 11 ]. Based on the current results, we found that there is further potential for optimization, especially during on-call periods.…”

“…Neuro-interventionalists were on-call on weekdays between 4:00 p.m. and 7:00 a.m., on weekends, and holidays. In June 2017, we implemented a team prenotification call, announcing the approximate arrival of the patient at the CSC to optimize workflow through the direct availability of stroke neurologists, neuro-interventionalists and anesthesiologists, as well as the CT scanner [ 11 ].…”

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

“…1 An early index of suspicion and an optimized diagnostic and treatment workflow is important. 3 4 EVT comprises the use of a device or occasionally intra-arterial pharmacological therapy to recanalize an occluded artery. Across multiple randomized clinical trials in the early and late window, recanalization has been proven to improve functional outcomes.…”