scholarly journals Implementation of the Protocol of Early Treatment of Acute Ischemic Stroke established for the first time at a public hospital in Rio de Janeiro

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 3) ◽  
pp. P77
Author(s):  
H Missaka ◽  
AR Tanaka ◽  
SL Fernandes ◽  
MAM Lima ◽  
CG Ponde ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Early Treatment ◽  
Rio De Janeiro ◽  
Public Hospital ◽  
First Time

Abstract TP251: Onset-to-Door Times and Means of Transportation for Acute Ischemic Stroke Patients Attending a Public Hospital in Bogota DC, Colombia. Is an Ambulance the Fastest Way to Reach the Hospital?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Javier Vicini-Parra ◽  
Jenny Ospina ◽  
Cristian Correa ◽  
Natalia Gomez ◽  
Stephania Bohorquez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Public Transportation ◽  
Public Hospital ◽  
Descriptive Analysis ◽  
First Year ◽  
Stroke Patients ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Ischemic Attack

Introduction: A prospective stroke database was implemented as part of a still-growing comprehensive stroke centre (CSC). This CSC is located within a referral public hospital (Hospital Occidente de Kennedy) in Bogota DC, Colombia , that serves 2.3 million people of mainly low economic income. In this abstract, we present the data pertaining patients who were thrombolysed in our institution during the first year of data collection, and specify onset-to-door (OTD) times as they relate to the means of transportation used. Hypothesis: Acute stroke patients who arrive in ambulance have the shortest onset-to-door times. Methods: Printed forms were filled for every patient who arrived with diagnosis of acute ischemic stroke (AIS) or transient ischemic attack (TIA). Data was transcribed to an electronic database (Numbers, Apple Inc.) and analyzed with SPSS Statistics version 23 (IBM Corporation). A retrospective descriptive analysis was performed for central tendency and dispersion measures. Results: Since August 1st 2014 until July 31st 2015, 39 patients (17.7% of AIS patients) were thrombolysed. Mean onset-to-door times are shown in table 1. Prenotification was received for only 1 patient. All patients came from their homes. Conclusions: Almost half of our thrombolysed patients arrived in taxi to our institution. Taxi was the fastest means of transportation, ambulance was the slowest and private cars were in the middle of those. This confirmed our suspicion that the state-owned emergency medical services (SEMD) are suboptimal and that stroke patients prefer to use public transportation rather than SEMD. This should warn public health authorities on he urgent need to improve our SEMD. In the meantime, this finding prompts us to include taxi drivers in our periodic stroke campaigns.

Abstract TP353: Use of Telestroke in a Metropolitan Stroke Code Process

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Amy Castle ◽  
Lana Stein ◽  
Sandra Hanson ◽  
Charles Ormiston ◽  
Karen Porth
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Decision Tree ◽  
Acute Ischemic Stroke ◽  
Early Treatment ◽  
Reperfusion Therapy ◽  
Limited Knowledge ◽  
Code Process ◽  
Metropolitan Hospital ◽  
Risk Of Treatment

BACKGROUND: Reperfusion therapy is the most important recent advance in early treatment for acute ischemic stroke, but remains underused and the timing of administration of treatment continues to be unacceptably delayed. The complexity of the decision tree and risk of treatment may be limiting use in the emergency department (ED) when those directing the therapy have limited knowledge and less comfort with administration of the drug. This review supports the hypothesis that utilizing telestroke to increase the Stroke Neurology expertise early in the stroke code in an organized stroke code process in a metropolitan hospital ED will improve the rate of use of reperfusion therapy and decrease the door-to-drug (DTD) times. METHODS and RESULTS: Telestroke was used to allow for Stroke Neurology presence and leadership in a redesigned stroke code process at 2 busy metropolitan hospitals beginning in 2009 at St. Joseph’s Hospital and 2010 at St. John’s Hospital. CONCLUSION: Telemedicine run stroke codes in a busy metropolitan ED resulted in increased use of reperfusion therapy and dramatic decreases in DTD times.

scholarly journals Early Mobilization in Ischemic Stroke: A Pilot Randomized Trial of Safety and Feasibility in a Public Hospital in Brazil

2015 ◽  
Vol 5 (1) ◽  
pp. 31-40 ◽  
Author(s):  
Simone Rosa Poletto ◽  
Letícia Costa Rebello ◽  
Maria Júlia Monteiro Valença ◽  
Daniele Rossato ◽  
Andrea Garcia Almeida ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Public Hospital ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Intervention Group ◽  
Total Duration ◽  
Early Mobilization ◽  
Functional Independence ◽  
Control Group

Background: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥85) were observed between the groups at the 3-month follow-up. Conclusions: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals.

Abstract 161: Lean Process Improvements Reduce Door to CT and Door to Needle Times for Acute Ischemic Stroke Patients

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cory McCann ◽  
Aleks Tkach ◽  
Adam de Havenon ◽  
Joel Loosli ◽  
Jamie Troyer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Improve Patient Safety ◽  
Post Intervention ◽  
Process Improvements ◽  
Slowing Down ◽  
Before And After ◽  
Ct Brain ◽  
Student’S T ◽  
First Time

Background: In late 2015, we assembled a multi-disciplinary team to analyze current emergency department (ED) processes and identify improvement opportunities in the current “brain attack” (BA) protocol. Using lean process engineering tools, including time study analysis, gemba walks, and cause and effect diagrams, we mapped our baseline state and identified delaying activities that did not add value to the BA process. We defined a new BA process (see Figure 1) to eliminate waste and improve team communication, including 3 Time Outs to ensure that increased speed didn’t decrease safety. Methods: To determine the effect of our intervention, we retrospectively reviewed patients who were admitted to our ED as a BA for evaluation of possible acute ischemic stroke and had a CT brain after ED arrival between April 2015 and August 2016. ED arrival was defined as the time that patients physically arrived at the ED and “time to CT” was the time from ED arrival to the first time stamp of the CT brain. The time from ED arrival to tPA bolus was also measured for "door to needle" time. The time to CT and door to needle times were compared between BA patients before and after lean process improvements using Student’s T-test. Results: Our cohort included 239 patients who presented to the ED as a BA. We included 116 BA patients from before the intervention and 123 from afterwards. The mean±SD time to CT prior to the intervention was 19.0±13.9 minutes. After our lean process improvements the time to CT was 14.2±15.6 minutes. The delta of 4.8 minutes resulted in a significant reduction in time to CT, p = 0.012. There were 14 patients who received tPA prior to the intervention and 9 afterwards, for a total of 23 door to needle times (10% of cohort). Door to needle time was significantly shortened post-intervention (46±13 minutes versus 32±12 minutes, p=0.013). Conclusions: Lean process improvement methodology significantly reduces door to CT and door to needle times, supporting current AHA Target: Stroke goals and allowing faster treatment of patients with acute ischemic stroke. Incorporating time-outs into standardized processes that aim to deliver care more quickly may improve patient safety without substantially slowing down DTN times. Further investigation is required to determine whether the new process improved safety and clinical outcomes.

scholarly journals Time to Thrombolysis and Long-Term Outcomes in Patients With Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (5) ◽  
pp. 1724-1732
Author(s):  
Adelina Yafasova ◽  
Emil Loldrup Fosbøl ◽  
Søren Paaske Johnsen ◽  
Christina Kruuse ◽  
Jeppe Kofoed Petersen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Cubic Spline ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Composite Outcome ◽  
Long Term Outcomes ◽  
First Time

Background and Purpose: It is well-established that increasing treatment delay reduces the benefits of thrombolysis in patients with acute ischemic stroke. However, most studies focus on short-term outcomes. This study examined long-term outcomes according to time to thrombolysis in patients with first-time ischemic stroke. Methods: In this nationwide cohort study, all Danish patients with first-time ischemic stroke treated with intravenous thrombolysis between 2011 and 2017 and alive at discharge were identified through the Danish Stroke Registry. The association between time from symptom onset to thrombolysis and the long-term rate of the composite of death and recurrent ischemic stroke was examined using multivariable Cox regression and restricted cubic spline analysis. Results: The study population included 6252 patients with first-time ischemic stroke treated with thrombolysis (median age, 69 years [25th–75th percentile 60–78 years], 60% men). The median follow-up was 2.5 years (25th–75th percentile 1.2–4.1 years). The median time to thrombolysis was 138 minutes (25th–75th percentile 101–185 minutes), and the median National Institutes of Health Stroke Scale score at presentation was 5 (25th–75th percentile 3–10). The absolute 3-year risk of the composite outcome was 19.0% (95% CI, 16.4%–21.8%) in the 0 to 90 minute group, 23.3% (21.8%–24.9%) in the 91 to 180 minute group, and 23.8% (21.6%–26.1%) in the 181 to 270 minute group. Compared with thrombolysis within 90 minutes, time to thrombolysis >90 minutes was associated with a higher rate of the composite outcome (91–180 minute: adjusted hazard ratio, 1.25 [95% CI, 1.06–1.48]; 181–270 minutes: adjusted hazard ratio, 1.35 [95% CI, 1.12–1.61]). In restricted cubic spline analysis, the rate of the composite outcome increased with increasing time to thrombolysis and leveled off after 138 minutes. Conclusions: In this nationwide cohort of patients with ischemic stroke, the long-term rate of the composite of death and recurrent ischemic stroke increased with increasing time from symptom onset to initiation of thrombolysis.

A Double-Blind Controlled Trial of Naloxone in Early Treatment of Acute Ischemic Stroke

1992 ◽  
Vol 2 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Anna Członkowska ◽  
Tadeusz Mendel ◽  
Maria Barańska-Gieruszczak
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Early Treatment ◽  
Controlled Trial ◽  
Double Blind
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