scholarly journals Emergency Care of Patients with Acute Ischemic Stroke in the Kaiser Permanente Southern California Integrated Health System

2016 ◽  
Keyword(s):  
Ischemic Stroke ◽  
Health System ◽  
Acute Ischemic Stroke ◽  
Emergency Care ◽  
Southern California ◽  
Kaiser Permanente ◽  
Integrated Health

Abstract TP248: The Kaiser Permanente Stroke EXPRESS Program: Improving DTN Time in a 21-hospital Integrated Healthcare System

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mai N Nguyen-Huynh ◽  
Jeffrey G Klingman ◽  
Andy Avins ◽  
Abigail Eaton ◽  
Sunil Bhopale ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Calendar Period ◽  
Large Vessel Occlusion ◽  
Kaiser Permanente ◽  
Vessel Occlusion ◽  
Integrated Healthcare ◽  
Core Group ◽  
Symptomatic Intracranial Hemorrhage

Background: Faster treatment with tPA in acute ischemic stroke is associated with better outcomes. Starting in 2015, Kaiser Permanente Northern California (KPNC) redesigned its acute stroke workflow across all 21 KPNC stroke centers to have all stroke alerts actively managed by a core group of vascular neurologists via telemedicine. We examined the effect of KPNC’s Stroke EXPRESS (EXpediting the PRrocess of Evaluating and Stopping Stroke) program on door-to-needle (DTN) time and symptomatic intracranial hemorrhage (sICH) rates. Methods: The Stroke EXPRESS program was rolled out across KPNC in a staggered fashion from 9/2015 to 1/2016 with the goals of expediting the evaluation and determination for tPA and speeding up the assessment for large vessel occlusion to allow for timely transfer for thrombectomy. We compared DTN times for 6 months before implementation to the same 6-month calendar period after implementation. Results: After implementation, tPA administrations increased from 38/month at baseline to 80/month (P<.001). Mean DTN times decreased significantly after implementation (40.8 ± 31.5 min vs. 61.3 ± 30.9 min at baseline, P<.001; median 33 min vs. 52 min, P<.001.) [Figure], and all centers achieved DTN time of <60 minutes routinely (88% vs 64%, Risk Ratio =1.4, p<.001). DTN times of < 30 min were much more common in the Stroke EXPRESS period (46% vs. 5% at baseline, P<0.001). There was no difference in sICH rates by ECASS criteria in the two periods: 4.3% vs. 4.3%, P=1.00. Conclusions: Implementation of the Stroke EXPRESS regional telemedicine program in KPNC was associated with an increase in tPA administrations, markedly shorter DTN times, and no change in the rate of sICH.

Abstract 2319: Improving Inter-facility Transfer Times for Acute Ischemic Stroke Patients: The Stroke Rescue Program

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jeffrey M Katz ◽  
Richard Libman ◽  
Paul M Power ◽  
Adelyn Tsu ◽  
Nimmy Thomas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Health System ◽  
Acute Ischemic Stroke ◽  
Treatment Guidelines ◽  
Phone Call ◽  
Network Efficiency ◽  
Transport Time ◽  
Total Transport ◽  
Comprehensive Stroke Center ◽  
Rapid Transfer

Background and Purpose: The inter-facility transfer of acute ischemic stroke (AIS) patients to a comprehensive stroke center (CSC) must be rapid. Transfer delays increase the likelihood of exclusion from endovascular stroke therapy and therefore are an obstacle to time sensitive stroke treatments. Reducing transport times and improving transfer efficiency is integral to the success of a comprehensive stroke network. Methods: The Stroke Rescue Program was created within a large metropolitan health system to facilitate the rapid transfer of AIS patients from regional (both health system (n=8) and non-system (n=4)) primary stroke centers (PSC) to the network's CSC. Program interventions included creation of a transfer center and stroke rescue hotline with a new priority dispatching protocol; standing order medical treatment guidelines with paramedic, referring physician and staff education; and the development of transport time elements and targets. Selected time elements included Transport 1 (Tr-1, initial phone call to EMS arrival at PSC), ED Time (PSC arrival to PSC departure), and Transport 2 (Tr-2, PSC departure to CSC arrival). Total transport time target was set at <60 min and to achieve this we aimed at decreasing ED Time. Results: Between January 1, 2010 and June 30, 2011, 128 patients underwent Stroke Rescue. The median PSC to CSC distance was 14.4 miles (range 3.0 to 32.1 miles). Ischemic stroke was confirmed in 116 (91%) patients and 65 (51%) patients were “drip and ship” transports (intravenous tPA infusion during Tr-2). Overall, median total transport time was 48 min (ED Time 18 min). Comparing first quarter 2010 (baseline quarter, n=21) to second quarter 2011 (most recent quarter, n=31), the percent transported within 60 min increased from 57% to 81%. Statistically significant improvement was seen for both median ED Time (23 min versus 14 min; U = 171, p <.01, r = .40) and median total transport time (56 min versus 44 min; U = 199, p <.05, r = .33). Conclusion: Process organization with inter-facility stroke transfer protocols that minimize the time paramedics spend in a PSC emergency department can significantly reduce transport duration making transfer for time limited stroke therapies practical. Further study is needed to determine whether improved stroke network efficiency translates into better clinical outcomes, but the concept of “time is brain” supports this approach.

scholarly journals The Effect of Implementing Initial Emergency Care Bundle on Early Outcomes among Acute Ischemic Stroke Patients

2021 ◽  
Vol 12 (1) ◽  
pp. 213-234
Author(s):  
Wafaa Wahdan Abd El-Aziz ◽  
Heba A. Al-Metyazidy ◽  
Hend Elsayed Mansour ◽  
Soheir M. Weheida
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Care ◽  
Care Bundle ◽  
Stroke Patients

scholarly journals Imbalanced Regional Development of Acute Ischemic Stroke Care in Emergency Departments in China

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Jianguo Li ◽  
Jingming Liu ◽  
Yuefeng Ma ◽  
Peng Peng ◽  
Xiaojun He ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Regional Development ◽  
Emergency Care ◽  
Regional Differences ◽  
Nationwide Survey ◽  
Stroke Care ◽  
The Status ◽  
The Impact ◽  
Structured Questionnaire

Objective. Most patients of acute ischemic stroke (AIS) receive treatments in the department of emergency in China. We aimed to examine the status of AIS diagnosis and treatment and the impact of green pathway operation in different regions of China. Methods. In this nationwide survey, information regarding the emergency care of AIS was collected from 451 hospitals in different regions of China, by interviewing 484 physicians from these hospitals. Structured questionnaire was used to explore the status of AIS care and impact of the green pathway. Results. 445 hospitals from 18 provinces, 4 municipalities, and 3 ethnic autonomous regions in China were included in the present study. Overall, the proportion of door-to-needle time (DNT) less than 60 min was 66.08% in the enrolled hospitals (n = 298). Stratified by regions, the results suggested that hospitals located in East regions had shorter DNT time (P=0.036), and more proportion of rtPA (P<0.001) than those in West regions. Further analysis suggested that hospitals with a green channel were more likely to shorten DNT and improve the proportion of rtPA (P<0.01). Conclusion. Considerable regional differences were observed in terms of DNT time and thrombolysis rates in the departments of emergency in China. Further studies are required to confirm the regional differences in AIS care in China.

scholarly journals Evaluation of Off-Hour Emergency Care in Acute Ischemic Stroke: Results from the China National Stroke Registry

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0138046 ◽  
Author(s):  
Guifen Wang ◽  
Gaifen Liu ◽  
Runhua Zhang ◽  
Ruijun Ji ◽  
Baoqin Gao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Care ◽  
Stroke Registry

A Systematic Review and Critical Appraisal of Quality Measures for the Emergency Care of Acute Ischemic Stroke

2014 ◽  
Vol 64 (3) ◽  
pp. 235-244.e5 ◽  
Author(s):  
Kori Sauser ◽  
James F. Burke ◽  
Mathew J. Reeves ◽  
William G. Barsan ◽  
Deborah A. Levine
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Care ◽  
Critical Appraisal ◽  
Quality Measures
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