Reduced Workflow Times for Reperfusion Therapy After Acute Ischemic Stroke Using a Visual Task Management Application
Reduced Workflow Times for Reperfusion Therapy After Acute Ischemic Stroke Using a Visual Task Management Application
复制标题
DOI：
10.1161/svin.122.000551
复制
发表时间：
2023-03-01
期刊：
影响因子：
--
通讯作者：
Kira，Jun-ichi
中科院分区：
文献类型：
--
作者：
Matsumoto，Shoji;Nakahara，Ichiro;Kira，Jun-ichi
背景再灌注治疗急性缺血性卒中的疗效是高度时间依赖性的，因此，卒中中心需要进一步减少从到达医院到有效治疗的延迟。我们开发了一个可视化的任务管理应用程序，任务计算中风（任务计算。卒中：TCS），通过支持并行工作人员完成任务来促进医院急性缺血性卒中治疗。我们评估TCS减少再灌注治疗延迟和改善临床outcomes.MethodsIn这个多中心队列研究，患者直接入住4个综合中风中心在日本，并给予静脉组织纤溶酶原激活剂和/或机械血栓切除术从2018年6月至2020年12月。研究小组访问了每个机构，并指导工作人员使用TCS治疗急性缺血性卒中（培训阶段），之后工作人员独立使用TCS（TCS阶段）。然后，我们根据训练前接受治疗的患者的改良兰金量表，比较了静脉组织纤溶酶原激活剂的入针时间、机械血栓切除术的入针时间和出院时的临床结局结果在研究期间，316例急性缺血性脑卒中患者接受了再灌注治疗;其中，246例接受静脉组织纤溶酶原激活剂治疗，162例接受机械血栓切除术（包括92例接受两种治疗）。平均门到针时间从初始阶段的58.0分钟显著缩短至培训阶段的54.6分钟（P=0.049）和TCS阶段的47.8分钟（P<0.001）。培训阶段的穿刺时间没有变化;但是，在TCS阶段，穿刺时间从初始阶段的93.8分钟显著减少至88.5分钟（P=0.004）。出院时改良兰金量表评分的分布在TCS分期显著有利地转移（P=0.003）。结论在这项研究中，TCS应用可以减少再灌注治疗的工作流程时间，并可能导致改善临床结局。
BackgroundReperfusion therapy for acute ischemic stroke efficacy is highly time dependent; therefore, stroke centers are required to further reduce the delays from hospital arrival to treatment efficiently. We developed a visual task management application, Task Calculation Stroke (Task Calc. Stroke: TCS), to facilitate hospital acute ischemic stroke treatment by supporting parallel staff task completion. We evaluated TCS for the reduction of reperfusion therapy delays and improvement of clinical outcomes.MethodsIn this multicenter cohort study, patients were directly admitted to 4 comprehensive stroke centers in Japan and given intravenous tissue plasminogen activator and/or mechanical thrombectomy from June 2018 to December 2020. The research team visited each facility and instructed the staff on TCS use for acute ischemic stroke (training stage), after which the staff used TCS independently (TCS stage). We then compared door‐to‐needle time for intravenous tissue plasminogen activator, door‐to‐puncture time for mechanical thrombectomy, and clinical outcomes at discharge according to the modified Rankin Scale among patients treated before training (original stage), during the training stage, or the TCS stage.ResultsDuring the study period, 316 patients with acute ischemic stroke received reperfusion therapy; of these, 246 received intravenous tissue plasminogen activator and 162 mechanical thrombectomy (including 92 receiving both the treatments). The mean door‐to‐needle time was significantly reduced from 58.0 minutes in the original stage to 54.6 minutes in the training stage (P=0.049) and 47.8 minutes in the TCS stage (P<0.001). The door‐to‐puncture time did not change during the training stage; however, in the TCS stage, it significantly reduced from 93.8 minutes in the original stage to 88.5 minutes (P=0.004). The distribution of modified Rankin Scale scores at discharge significantly shifted favorably at the TCS stage (P=0.003).ConclusionIn this study, TCS application could reduce workflow time for reperfusion therapy and might have led to improved clinical outcomes.