Acute stroke care at rural hospitals in Idaho: Challenges in expediting stroke care
Acute stroke care at rural hospitals in Idaho: Challenges in expediting stroke care
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DOI：
10.1111/j.1748-0361.2006.00004.x
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发表时间：
2006-12-01
影响因子：
4.9
通讯作者：
Norris, TE
中科院分区：
文献类型：
--
作者：
Gebhardt, JG;Norris, TE
背景：溶栓药物是目前治疗中风最有效的方法。然而，国家神经疾病和中风研究所关于开始溶栓治疗的标准，最明显的是症状发作后3小时的时间限制，已证明对许多农村医院来说具有挑战性。目的：提供爱达荷州农村医院中风护理的快照，并调查这些医院在加速中风护理方面的经验。方法：采用标准问卷，对爱达荷州21所乡村医院的医务人员进行电话调查。调查的重点是急性中风护理实践和策略，以加快中风护理。结果：每年接受治疗的中风患者的中位数为23.3。77.8%的医院报告了患者延误，66.7%的医院报告了运输延误，61.1%的医院报告了院内延误，22.2%的医院报告了设备延误，61.1%的医院报告了辅助服务延误。大约67%的医院实施了卒中临床路径，80.0%的医院为工作人员提供了卒中特异性培训。没有一家接受调查的医院有指定的中风团队，只有33.3%的医院报告说，他们正在努力提高质量，以加快中风护理。在55.6%的调查医院中，溶栓药物（tPA）可用并适用于卒中。结论：爱达荷州的农村医院在奋进满足溶栓治疗的3小时最后期限时面临许多困难的挑战，包括有限的资源和急性中风护理经验，以及许多不同类型的院前和院内延误。
Context: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. Purpose: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Methods: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. Findings: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Conclusions: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays.