Protocols for Endovascular Stroke Treatment Diminish the Weekend Effect Through Improvements in Off-Hours Care
Protocols for Endovascular Stroke Treatment Diminish the Weekend Effect Through Improvements in Off-Hours Care
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DOI：
10.3389/fneur.2018.01106
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发表时间：
2018-12-18
影响因子：
3.4
通讯作者：
Leslie-Mazwi, Thabele M.
中科院分区：
文献类型：
--
作者：
Raymond, Scott B.;Akbik, Feras;Leslie-Mazwi, Thabele M.
简介：周末效应是一种众所周知的现象，在正常工作时间之外发生的急性中风患者的预后会恶化。这是由于整个星期和晚上的服务可用性不统一，尽管针对静脉溶栓候选者进行了描述，但对血管内卒中护理的了解却很少。我们评估了机构方案对周末效应的影响，以及血管内治疗的速度和结果作为就诊时间的函数。方法：本研究评估了 129 名连续患者的前瞻性观察队列。根据正常工作时间（周一至周五，07:00-19:00）与非工作时间（夜间 19:00-07:00 和周末）的就诊时间对患者进行分组，并评估治疗潜伏期和结果。结果：治疗潜伏期并不取决于就诊时间。正常时间和非工作时间的成像时间间隔相当（中位时间分别为 21 分钟和 19 分钟，p < 0.50）。成像与腹股沟穿刺具有可比性（71 分钟与 71 分钟，p < 1.0），血管造影和功能结果也是如此。此外，治疗间隔随着方案经验的增加而缩短；从研究期间的第一季度到第四季度，入院至穿刺时间间隔显着缩短（分别为 115 分钟与 94 分钟，p < 0.006），其效果主要在非工作时间显现，入院至穿刺时间中位数减少了 28%。 结论：机构方案有助于减少血管内卒中治疗中的周末效应。这主要是由于非工作时间表现的改善，随着时间的推移，遵守协议导致治疗间隔进一步减少。
Introduction: The weekend effect is a well-recognized phenomenon in which patient outcomes worsen for acute strokes presenting outside routine business hours. This is attributed to non-uniform availability of services throughout the week and evenings and, though described for intravenous thrombolysis candidates, is poorly understood for endovascular stroke care. We evaluated the impact of institutional protocols on the weekend effect, and the speed and outcome of endovascular therapy as a function of time of presentation.Method: This study assesses a prospective observational cohort of 129 consecutive patients. Patients were grouped based on the time of presentation during regular work hours (Monday through Friday, 07:00-19:00 h) vs. off-hours (overnight 19:00-07:00 h and weekends) and assessed for treatment latency and outcome.Results: Treatment latencies did not depend on the time of presentation. The door to imaging interval was comparable during regular and off-hours (median time 21 vs. 19 min, respectively, p < 0.50). Imaging to groin puncture was comparable (71 vs. 71 min, p < 1.0), as were angiographic and functional outcomes. Additionally, treatment intervals decreased with increased protocol experience; door-to-puncture interval significantly decreased from the first to the fourth quarters of the study period (115 vs. 94 min, respectively, p < 0.006), with the effect primarily seen during off-hours with a 28% reduction in median door-to-puncture times.Conclusions: Institutional protocols help diminish the weekend effect in endovascular stroke treatment. This is driven largely by improvement in off-hours performance, with protocol adherence leading to further decreases in treatment intervals over time.