The quality of treatment of hyperacute ischemic stroke in Canada: a retrospective chart audit

Ganesh, Aravind; Camden, Marie Christine; Lindsay, Patrice; Kapral, Moira K.; Côté, Robert; Fang, Jiming; Zagorski, Brandon; Hill, Michael D

doi:10.9778/cmajo.20140067

Cited by 27 publications

(28 citation statements)

References 29 publications

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“…The death rate in this study was similar to that found by Schmidt et al, (30) Al-Khaled et al, (20) Ganesh et al (22) and Tong et al, (15) with 6%, 8.2%, and 7.2%, respectively. In clinical practice, ischemic stroke patients treated with rt-PA present better outcomes when compared to those who do not receive rt-PA.…”

Section: Discussionsupporting

confidence: 90%

“…Thus, prolonged time window is one of the main barriers to conducting thrombolysis at hospitals. (15,22) In this study, door-to-needle time was elevated and higher than that recommended by Brazilian guidelines on ischemic stroke treatment, (23) which establish a maximum of 60 minutes. Strbian et al (24) and Fonarow et al (25) obtained 77-and 40-minute door-to-needle times, respectively.…”

Section: Discussionmentioning

confidence: 47%

“…Of these, 19 (1.1%) were treated with rt-Pa. In Canada, Ganesh et al (22) found a mean time of 190 minutes. A prolonged time window is associated with delays due to the general public's failure to recognize stroke symptoms and the consequent delay in prehospital care and transportation.…”

Section: Discussionmentioning

confidence: 99%

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Desfechos clínicos de pacientes com acidente vascular cerebral isquêmico após terapia trombolítica

et al. 2016

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Objective: To analyze outcomes and associated factors in ischemic stroke patients submitted to thrombolytic therapy. Methods: This was a retrospective cohort study of ischemic stroke patients submitted to thrombolytic therapy. Comorbidities, neurologic deficits and time of thrombolysis were described. The chi-squared test was used to assess association among comorbidities, time of thrombolysis, and occurrence of hemorrhagic transformation. Results: There was a high frequency of comorbidities. Mean neurological deficit score was 15 points. Mean time window was 98 minutes and needle-to-door time, 89.9 minutes. Hemorrhagic transformation was observed in 20 patients. Bivariate analysis revealed that hemorrhagic transformation was associated with greater neurologic deficit score, atrial fibrillation and heart disease. Neurologic deficit fell from 51% to 12.5% between admission and discharge. Conclusion: Thrombolytic therapy presented positive outcomes, regardless of long thrombolysis time and high neurologic deficit scores. ResumoObjetivo: Analisar desfechos e fatores associados em pacientes com acidente vascular cerebral isquêmico após terapia trombolítica. Métodos: Estudo do tipo coorte retrospectivo de pacientes com acidente vascular cerebral isquêmico submetidos à terapia trombolítica. Foram descritas as comorbidades; os défices neurológicos e os tempos de atendimento. Utilizou-se o teste qui quadrado para associação entre comorbidades, tempos de atendimento e ocorrência de transformação hemorrágica. Resultados: Houve elevada frequência de comorbidades. Défices neurológicos pontuaram média de 15 pontos. A janela de tempo obteve média de 98 minutos e o tempo porta-agulha, 89,8 minutos. Observouse transformação hemorrágica em 20 pacientes. Na análise bivariada, a ocorrência de transformação hemorrágica esteve associada com maior défice neurológico, fibrilação atrial e cardiopatia. Houve redução dos défices neurológicos de 51% para 12,5 entre a admissão e alta. Conclusão: A terapia trombolítica apresentou resultados positivos, apesar de tempos de atendimento elevados e pacientes com défices neurológicos com elevada pontuação.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 47%

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Desfechos clínicos de pacientes com acidente vascular cerebral isquêmico após terapia trombolítica

et al. 2016

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“…A high number of treated patients reflects fast collaborative work in acute stroke-ready hospitals 1 . Tipically, these hospitals have structured acute stroke teams, carefully studied and written protocols, fast laboratory and neuroimaging testing, and exhibit major involvement of emergency medical services and personnel 2 .…”

mentioning

confidence: 99%

“…This depends on a coordinated effort of policy makers, Health insurance companies and local facilities. Federal, State and local Government should be responsible for adequate funding of public services, human and technological resources (e.g., telethrombolysis, immediate rescue of patients in remote areas); coordinate different public and private agents (e.g., primary or comprehensive stroke centers and more simple facilities benefiting from effective telemedicine use and drip and ship strategies); legislate and supervise the adequacy of services provided, and improve public education about stroke signs and symptoms, preparedness and effective action 1,3 . Any hospital dealing with a significant number of acute stroke patients should carefully develop and control the processes involved.…”

mentioning

confidence: 99%

Stroke treatment: metrics and processes

André

2015

Arq. Neuro-Psiquiatr.

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T he proportion of cerebral infarct patients receiving intravenous thrombolysis is a sensible and logic marker of stroke care quality. A high number of treated patients reflects fast collaborative work in acute stroke-ready hospitals 1 . Tipically, these hospitals have structured acute stroke teams, carefully studied and written protocols, fast laboratory and neuroimaging testing, and exhibit major involvement of emergency medical services and personnel 2 .Increasing the number of IV rT-PA treated patients should be considered a high priority for acute stroke hospitals. This depends on a coordinated effort of policy makers, Health insurance companies and local facilities. Federal, State and local Government should be responsible for adequate funding of public services, human and technological resources (e.g., telethrombolysis, immediate rescue of patients in remote areas); coordinate different public and private agents (e.g., primary or comprehensive stroke centers and more simple facilities benefiting from effective telemedicine use and drip and ship strategies); legislate and supervise the adequacy of services provided, and improve public education about stroke signs and symptoms, preparedness and effective action 1,3 . Any hospital dealing with a significant number of acute stroke patients should carefully develop and control the processes involved. Ideally, this should include all evaluation and treatment phases -from pre-hospital management to post-discharge care and rehabilitation . The authors focus on the hyperacute phase assessment and management. They emphasize the need of a critical evaluation of the chain of steps that may constitute barriers to speed the use of IV rT-PA. Improvement of those steps, gaining more time and leading to a higher number of patients treated within the golden 90 minutes-window is suggested. They provide references from institutions that have achieved a significant decrease in average onset-to-treatment time (OTT) to IV thrombolysis. Unfortunately, this does not necessarily result in better outcomes. These somewhat deceiving final results could be due to a non-significant increase in the proportion of patients treated within the 90-minute frame.Constant effort to improve workflow metrics should be part of the institution's commitment to high-quality stroke management. It should be acknowledged, however, that mean or median OTT cannot tell us the whole story 9,10 . Central tendency measures may represent a final result of divergent forces: greater symptom recognition by the public and more efficient hospital processes, and, on the other hand, the parallel inclusion of more patients in the extended 3 to 4.5 hour-window.Li and Johnson also propose the use of a specific approach -Lean-Six-Sigma -to rationally speed the management processes emphasizing on-site observation of the entire chain of steps 8 . This is followed by preferential intervention on those steps that can add most value -i.e., speed -to the process. The method has already been applied to hospital processes 11 . U...

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10-year Temporal Trends of Intravenous Thrombolysis in Acute Ischemic Stroke: Analysis of the China National Stroke Registry I–Ⅲ

Jia,

Jiang,

et al. 2024

Journal of Stroke and Cerebrovascular Diseases

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The quality of treatment of hyperacute ischemic stroke in Canada: a retrospective chart audit

Cited by 27 publications

References 29 publications

Desfechos clínicos de pacientes com acidente vascular cerebral isquêmico após terapia trombolítica

Desfechos clínicos de pacientes com acidente vascular cerebral isquêmico após terapia trombolítica

Stroke treatment: metrics and processes

10-year Temporal Trends of Intravenous Thrombolysis in Acute Ischemic Stroke: Analysis of the China National Stroke Registry I–Ⅲ

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