Time to acute stroke treatment in‐hours was more than halved after the introduction of the Helsinki Model at Westmead Hospital

Abstract

Background Management of acute ischaemic stroke is time critical. Reducing time to treatment with thrombolysis is strongly associated with improved outcomes in properly selected patients. However, there are barriers to ensuring timely treatment in the hospital setting. Aim To determine if simple, no‐cost protocol changes could improve time to treatment for acute ischaemic stroke at a busy tertiary hospital. Methods Prospectively collected routine clinical data were compared retrospectively before and after a protocol change designed to mirror the successful model from Helsinki University Central Hospital. Consecutive patients who activated a ‘code stroke’ (presentation consistent with acute stroke, eligible for acute stroke therapy) during working hours were included. Results Prior to the protocol change, 143 patients activated a code stroke, and 30 patients received thrombolysis. Following the protocol change, 134 patients activated a code stroke, and 14 patients received thrombolysis. The median time to administer thrombolysis was reduced from 76 min (interquartile range 54–91) to 33 min (27–44), P < 0.01. The median time to perform diagnostic computed tomography was unchanged between the two groups, 23 (14–54) min versus 22 (9–49) min, P = 0.12. However, this was reduced on subgroup analysis of patients whose arrival was pre‐notified by the ambulance service, 16 (9–22) min versus 8 (4–14) min, P < 0.01. Conclusion Time to treatment in acute stroke was dramatically improved with a simple intervention. This was achieved without a large stroke team or additional funding, making it highly accessible to other health services also seeking to improve their stroke service.

Reducing care time after implementing protocols for acute ischemic stroke: a systematic review

“…Out of 35 articles included in this review, 34 (97.1%) 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 were published in English and one (2.9%) 46 in both English and Spanish. Regarding the origin of the selected studies, 15 (42.9%) studies were performed in the Americas, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 10 (28.6%) in Europe, 14 15 20 23 27 29 32 34 35 46 7 (20.0%) in Asia, 12 19 25 28 33 36 43 and 3 (8.6%) in Oceania.…”

“…Regarding the origin of the selected studies, 15 (42.9%) studies were performed in the Americas, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 10 (28.6%) in Europe, 14 15 20 23 27 29 32 34 35 46 7 (20.0%) in Asia, 12 19 25 28 33 36 43 and 3 (8.6%) in Oceania. 16 41 42 From the included articles, 15 (42.9%) were performed in the United States of America, 13 17 18 21 22 24 26 30 31 37 38 39 40 44 45 4 (11.4%) in China, 12 25 36 43 3 (8.6%) in Australia, 16 41 42 2 (5.7%) in Japan, 19 33 2 (5.7%) in the Netherlands, 23 34 2 (5.7%) in Norway, 14 35 and 7 (20.0%) in varying countries 15 20 27 28 29 32 46 (…”

Ten Years of Improving Acute Stroke Management in a Metropolitan Area: A Population-Based Quantification of Quality Indicators

“…The analysis gives the opportunity to observe changes in stroke care of a large cohort of patients over a 10-year period and representative for a metropolitan region. Comparable to other projects, as, for example, the Helsinki model [19], the processes of acute stroke care could be improved relevantly and stable over the last 10 years.…”

In‐hospital acute stroke workflow in acute stroke – Systems‐based approaches

“…Despite limited generalizability of results due to the single‐centre nature of the study and milder stroke severity of the patient population, the reduction in DNT by 14 minutes with subsequent improvement in 90‐day clinical outcomes demonstrates the efficacy of systems interventions 40 . The implementation of the optimized Helsinki workflow in Australian stroke centres has resulted in median DNT reductions of 15 and 43 minutes in Melbourne and Sydney, respectively 41,42 . The variability in clinical effect is likely a result of difficulties transferring the protocol in an out‐of‐hours setting due to the lack of on‐site stroke personnel, demonstrated by unchanged DNT out‐of‐hours in the Melbourne study 41 .…”

“…40 The implementation of the optimized Helsinki workflow in Australian stroke centres has resulted in median DNT reductions of 15 and 43 minutes in Melbourne and Sydney, respectively. 41,42 The variability in clinical effect is likely a result of difficulties transferring the protocol in an out-of-hours setting due to the lack of on-site stroke personnel, demonstrated by unchanged DNT out-of-hours in the Melbourne study. 41 These results were replicated in a 2018 prospective registry implementing the Helsinki model, 43 with a significantly shorter median DNT that extended to the out-of-hours setting despite a lack of specialized stroke team and transfer delays.…”