Ambulance waiting and associated work flow improvement strategies: a pilot study to improve door-in-door-out time for thrombectomy patients in a primary stroke center
Ambulance waiting and associated work flow improvement strategies: a pilot study to improve door-in-door-out time for thrombectomy patients in a primary stroke center
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DOI：
10.1136/neurintsurg-2021-017653
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发表时间：
2021-07-12
影响因子：
4.8
通讯作者：
O'Brien, Paul
中科院分区：
文献类型：
--
作者：
Gaynor, Eva;Griffin, Emma;O'Brien, Paul
背景大血管闭塞(LVO)急性缺血性卒中(AIS)患者快速行血栓切除术是改善预后的关键。“滴水一船”模式面临的一大挑战是缩短进门到出门时间(DIDO)。我们提出了一种新的协议，目的是在不影响紧急服务使用时间的情况下，减少DIDO。方法选择2018年10月至2021年1月在某卒中中心(PSC)连续入院的疑似LVO AIS患者为研究对象。到达后，救护车工作人员仍与病人在一起。在立即进行临床和放射学评估后，患者由相同的等待人员转移到综合卒中中心(CSC)。收集了关键时间指标，并与新协议之前的历史数据进行了比较。结果27例患者同期行机械取栓术，发生左冠状动脉左室口狭窄。与历史组相比，DIDO时间显著减少(中位数45分钟对96分钟；p
Background Rapid access to thrombectomy for patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) is critical for improving outcome. A major challenge for the 'drip and ship' model is reducing the door-in-door-out time (DIDO). We propose a new protocol with the aim of reducing DIDO, without adversely affecting emergency service usage time. Methods Consecutive patients with suspected LVO AIS admitted to a Primary Stroke Center (PSC) from October 2018 to January 2021 were included. On arrival, the ambulance crew remained with the patient. Following immediate clinical and radiological evaluation, patients were transferred to the Comprehensive Stroke Center (CSC) by the same waiting crew. Key time metrics were collected and compared with historical data prior to the new protocol. Results 27 patients had an LVO amenable for mechanical thrombectomy during the time period. There was a significant reduction in the DIDO times compared with the historical group (median 45 min vs 96 min; p