Establishing Recommendations for Stroke Systems in the Thrombectomy Era The Upstate New York Stakeholder Proceedings
Establishing Recommendations for Stroke Systems in the Thrombectomy Era The Upstate New York Stakeholder Proceedings
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DOI：
10.1161/strokeaha.117.017412
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发表时间：
2017-07-01
期刊：
影响因子：
8.3
通讯作者：
Levine, Steven R.
中科院分区：
文献类型：
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作者：
Magdon-Ismail, Zainab;Benesch, Curtis;Levine, Steven R.
背景和目的-美国心脏协会/美国中风协会和卫生部中风Coverdell计划召开了一个利益相关者会议在纽约州北部制定建议，以提高中风系统急性大血管occlusion. Methods院前，医院和卫生部的领导被邀请（n=157）。参与者提供了目标/关注点，并制定了院前分诊和机构间转运的建议，使用3级影响（A [高]、B和C [低]）和实施可行性（1 [高]、2和3 [低]）量表对每个进行评级。六周后，与会者最终确定了建议。结果-71个利益相关者（45%的受邀者）出席。围绕目标/关注点出现了六个主题：（1）紧急医疗服务能力，（2）有效的院前筛查工具，（3）设施能力，（4）分类/运输指南，（5）数据采集/反馈工具，（6）设施竞争。作为回应，高影响（A级）院前建议，按实施可行性分层，是（1）使用在线医疗控制分诊（6%）;（2）区域运输策略（31%），标准化的紧急医疗服务清单（18%），质量指标（14%），标准化的院前筛查工具（13%），和绩效改进反馈（7%）;以及（3）用于筛查/决策的智能手机应用程序算法（6%）和基于救护车的远程医疗（6%）。A级机构间转移建议为（1）标准化转移流程（32%）/时间目标（16%）/区域化系统（11%）、性能指标（11%）、图像共享能力（7%）;（2）提供者教育（9%）和卒中工具箱（5%）;和（3）设施间远程医疗（7%）和反馈（2%）。结论-所使用的方法和产生的建议提供了中风系统增强模型。实施可能因地域需求/能力而异，并取决于建立标准护理做法。需要进一步研究，以制定最佳执行战略。
Background and Purpose-The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion.Methods-Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale. Six weeks later, participants finalized recommendations.Results-Seventy-one stakeholders (45% of invitees) attended. Six themes around goals/concerns emerged: (1) emergency medical services capacity, (2) validated prehospital screening tools, (3) facility capability, (4) triage/transport guidelines, (5) data capture/feedback tools, and (6) facility competition. In response, high-impact (level A) prehospital recommendations, stratified by implementation feasibility, were (1) use of online medical control for triage (6%); (2) regional transportation strategy (31%), standardized emergency medical services checklists (18%), quality metrics (14%), standardized prehospital screening tools (13%), and feedback for performance improvement (7%); and (3) smartphone application algorithm for screening/decision-making (6%) and ambulance-based telemedicine (6%). Level A interfacility transfer recommendations were (1) standardized transfer process (32%)/timing goals (16%)/regionalized systems (11%), performance metrics (11%), image sharing capabilities (7%); (2) provider education (9%) and stroke toolbox (5%); and (3) interfacility telemedicine (7%) and feedback (2%).Conclusions-The methods used and recommendations generated provide models for stroke system enhancement. Implementation may vary based on geographic need/capacity and be contingent on establishing standard care practices. Further research is needed to establish optimal implementation strategies.