Evaluation of Intervention Program on Shortening the Door-to-needle Times in Emergency Department Patients with Acute Stroke
Date Issued
2012
Date
2012
Author(s)
Hsieh, Ming-Ju
Abstract
Background
Recently, stroke is the third leading cause of death in Taiwan. About 70％ of stroke is ischemic stroke. Thrombolytic therapy has been proved to improve the functional outcome of the patients with acute ischemic stroke. In addition, It also has been shown that the sooner the stroke patients receiving thrombolytic therapy, the better the functional outcome. Door-to-needle time is defined as the time duration from patients arriving at emergency department (ED) to patients starting to receive thrombolytic therapy. Shortening the door-to-needle time not only increases the effects of thrombolytic therapy but also lowers the risk of complications induced by the therapy. One intervention program on shortening the door-to-needle times in ED patients with acute stroke has performed in the hospital and is under the period of maturity. The intervention program was launched step by step since August 1, 2010. The aim of our study is to evaluate the intervention program. We also want to search the factors affecting the door-to-needle time.
Material and Methods
Our study compared the condition of the evaluation period from March 1, 2011 to July 31, 2011 with those of the pre-intervention period from January 1, 2010 to July 31, 2010. The evaluation measures included the door-to-needle time, the time duration from patients arriving at ED to computed tomography being finished (door-to-CT time) and the percentage of patients with thrombolytic therapy among ischemic stroke patients. The inclusion criteria were as follows: (1) patients arriving at ED within 3 hours after symptoms onset (2) ischemic stroke patients diagnosed by neurologists or neuroimaging results. Patients with in-hospital stroke, or patients transferred from other hospitals for thrombolytic therapy were excluded. The trained stroke registrar collected the demographics and the in-hospital stroke data of the study group retrospectively. The pre-hospital data was collected at the same time. We also acquired the time of finishing computed tomography (CT) and ED overcrowding variables from the medical information system of the hospital.
Results
A total of 607 patients during the pre-intervention period and 554 patients during the evaluation period diagnosed as stroke and transient ischemic stroke visited ED within 10 days after symptoms onset. After excluding patients with intra-cerebral hemorrhage, subarachnoid hemorrhage, transient ischemic stroke, in-hospital stroke, patients arriving at ED more than 3 hours after stroke onset and patients transferred from other hospitals for thrombolytic therapy, there were 106 patients during the pre-intervention period and 90 patients during the evaluation period into our study group. Fifty-seven patients of our study group received thrombolytic therapy with 18 patients during the pre-intervention period. The median of door-to-needle time decreased from 66.5 minutes to 53 minutes significantly after intervention program was performed (p=0.03). The door-to-CT time decreased from 42.5 minutes to 11.6 minutes significantly (p<0.01). The percentage of patients with thrombolytic therapy among ischemic stroke patients increased from 4.19％ to 9.95％ (p<0.01). Intervention program was the only factor affecting the door-to-needle time≦60 minutes (p=0.03). No association was noted between age and the door-to-needle time≦60 minutes. The pre-hospital operation period was not different significantly (22.5 minutes vs. 24 minutes, p=0.43).
Conclusion
Our study revealed that the intervention program shortened the door-to-CT time and the door-to-needle time significantly. The intervention program achieved the goals of management time recommended by the American Heart Association guideline. In addition, the percentage of patients with thrombolytic therapy among ischemic stroke patients also increased significantly after intervention program was implemented. Nevertheless, the duration of pre-hospital operation period did not change. Our study showed that the intervention program effectively improved the quality of care in patients with acute stroke.
Subjects
stroke
thrombolytic therapy
organization and administration
quality
Type
thesis
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