040 The quest to reduce stroke treatment delays at a melbourne metropolitan primary stroke centre over the last two decades

To improve quality and to overcome the wide discrepancies in stroke care both within- and between European countries, the European Stroke Organisation Executive Committee initiated in 2007 activities to establish certification processes for stroke units and stroke centres. The rapidly expanding evidence base in stroke care provided the mandate for the European Stroke Organisation Stroke Unit-Committee to develop certification procedures for stroke units and stroke centres with the goals of setting standards for stroke treatment in Europe, improving quality and minimising variation. The purpose of this article is to present the certification criteria and the auditing process for stroke units and stroke centres that aim to standardise and harmonise care for stroke patients, and hence become members of the European Stroke Organisation Stroke Unit and Stroke Centre network. Standardised application forms and guidelines for national and international auditors have been developed and updated by members of the European Stroke Organisation Stroke Unit-Committee. Key features are availability of trained personnel, diagnostic equipment, acute treatment and collaboration with other stroke-caregivers. After submission, the application is reviewed by one national and two international auditors. Based on their reports, the Stroke Unit-Committee will make a final decision. Validating on-site visits for a subset of stroke units and stroke centres are planned. We herein describe a novel, European Stroke Organisation-based online certification process of stroke units and stroke centres. This is a major step forward towards high-quality stroke care across Europe. The additional value by connecting high-quality European Stroke Organisation Stroke Unit and Stroke Centre is facilitation of future collaboration and research activities, enabling building and maintenance of a high-quality stroke care network in Europe.

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Workflow patterns and potential for optimization in endovascular stroke treatment across the world: results from a multinational survey

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015902 ◽

2020 ◽

pp. neurintsurg-2020-015902

Author(s):

Johanna Maria Ospel ◽

Mohammed A Almekhlafi ◽

Bijoy K Menon ◽

Nima Kashani ◽

René Chapot ◽

...

Keyword(s):

Working Environment ◽

Specific Information ◽

Career Stage ◽

X Rays ◽

Ct Scanner ◽

Treatment Delays ◽

Stroke Treatment ◽

Physician Characteristics ◽

Set Up ◽

Improve Patient

BackgroundThe benefit of endovascular treatment (EVT) is highly time-dependent, and treatment delays reduce patients’ chances to achieve a good outcome. In this survey-based study, we aimed to evaluate current in-hospital EVT workflow characteristics across different countries and hospital settings, and to quantify the time-savings that could be achieved by optimizing particular workflow steps.MethodsIn a multinational survey, neurointerventionalists were asked to provide specific information about EVT workflows in their current working environment. Workflow characteristics were summarized using descriptive statistics and stratified by country and physician characteristics, such as age, career stage, personal and institutional caseload.ResultsAmong 248 respondents from 48 countries, pre-notification of the neurointerventional team was used in 70% of cases. The emergency department (ED) and CT scanner, and the CT scanner and neuroangiography suite, were on different floors in 23% and 38%, respectively. Redundant procedures in the ED were often routinely performed, such as chest x-rays (in 6%). General anesthesia was the most frequently used anesthesia protocol for EVT (42%), and an anesthesiologist was available in 82% for this purpose. 52% of the participants used a pre-prepared EVT kit.ConclusionThe current structure of EVT workflows offers possibilities for improvement. While some bottlenecks, such as the spatial department set-up, cannot easily be resolved, pre-notification tools and pre-prepared EVT kits are more straightforward to implement and could help to reduce treatment delays, and thereby improve patient outcomes.

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Abstract 2722: Anti-hypertensive Treatment Prolongs tPA Door-to-treatment Time: Secondary Analysis Of The Increasing Stroke Treatment Through Interventional Behavior Change Tactics (INSTINCT) Trial.

Stroke ◽

10.1161/str.43.suppl_1.a2722 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Lesli E Skolarus ◽

Phillip A Scott ◽

James F Burke ◽

Eric E Adelman ◽

Shirley M Frederiksen ◽

...

Keyword(s):

Treatment Time ◽

Secondary Analysis ◽

Secondary Data ◽

Educational Interventions ◽

Stroke Severity ◽

Stroke Patients ◽

Treatment Delays ◽

Stroke Treatment ◽

Stroke Risk Factors ◽

Propensity Matching

Background/Purpose: Increased time to tPA treatment is associated with worse outcomes. Thus, identifying modifiable treatment delays may improve stroke outcomes. We hypothesized that pre-thrombolytic anti-hypertensive treatment (AHT) may prolong door to treatment time (DTT). Methods: Secondary data analysis of consecutive tPA-treated patients at 24 randomly selected Michigan community hospitals in the INSTINCT trial. DTT among stroke patients who received pre-thrombolytic AHT were compared to those that did not receive pre-thrombolytic AHT. We then calculated a propensity score for the probability of receiving pre-thrombolytic AHT using a logistic regression model with covariates including demographics, stroke risk factors, antiplatelet or beta blocker as home medication, stroke severity (NIHSS), onset to door time, admission glucose, pretreatment systolic and diastolic blood pressure, EMS usage and location at time of stroke. A paired t-test was then performed to compare the DTT between the propensity matched groups. A separate generalized estimating equations (GEE) approach was also used to estimate the differences between patients receiving pre-thrombolytic AHT and those that did not while accounting for within hospital clustering. Results: A total of 557 patients were included in INSTINCT, however onset, arrival or treatment times were not able to be determined in 23, leaving 534 patients for this analysis. The unmatched cohort consisted of 95 stroke patients who received pre-thrombolytic AHT and 439 stroke patients who did not receive AHT from 2007-2010 ( table ). In the unmatched cohort, patients who received pre-thrombolytic AHT had a longer DTT (mean increase 9 minutes; 95% confidence interval (CI) 2-16 minutes) than patients who did not receive pre-thrombolytic AHT. After propensity matching (table), patients who received pre-thrombolytic AHT had a longer DTT (mean increase 10.4 minutes, 95% CI 1.9 - 18.8) than patients who did not receive pre-thrombolytic AHT. This effect persisted and its magnitude was not altered by accounting for clustering within hospitals. Conclusion: Pre-thrombolytic AHT is associated with modest delays in DTT. This represents a feasible target for physician educational interventions and quality improvement initiatives. Further research evaluating optimum hypertension management pre-thrombolytic treatment is warranted.

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Early Impact of the COVID-19 Pandemic on Acute Stroke Treatment Delays

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.160 ◽

2020 ◽

pp. 1-5

Author(s):

Joel Neves Briard ◽

Célina Ducroux ◽

Grégory Jacquin ◽

Walid Alesefir ◽

William Boisseau ◽

...

Keyword(s):

Acute Stroke ◽

Negative Impact ◽

Reperfusion Therapy ◽

Observational Cohort Study ◽

Treatment Delays ◽

Stroke Treatment ◽

Time Period ◽

Observational Cohort ◽

Comprehensive Stroke Center ◽

Stroke Center

ABSTRACT: This is an observational cohort study comparing 156 patients evaluated for acute stroke between March 30 and May 31, 2020 at a comprehensive stroke center with 138 patients evaluated during the corresponding time period in 2019. During the pandemic, the proportion of COVID-19 positive patients was low (3%), the time from symptom onset to hospital presentation was significantly longer, and a smaller proportion of patients underwent reperfusion therapy. Among patients directly evaluated at our institution, door-to-needle and door-to-recanalization metrics were significantly longer. Our findings support concerns that the current pandemic may have a negative impact on the management of acute stroke.

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Abstract P108: Impact of the Covid-19 Pandemic on Hyperacute Stroke Treatment: Experience From a Comprehensive Stroke Centre in Singapore

Stroke ◽

10.1161/str.52.suppl_1.p108 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Prakash R Paliwal ◽

Benjamin Y Tan ◽

Aloysius Leow ◽

Sunny Sibi ◽

Daniel Chor ◽

...

Keyword(s):

Severe Disease ◽

Western Region ◽

Outbreak Response ◽

Single Centre ◽

Stroke Treatment ◽

Neurological Outcomes ◽

Hyperacute Stroke ◽

Response System ◽

Observational Cohort ◽

Stroke Centre

Background: The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. Objectives: We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. Methods: This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. Results: We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p =0.004, 95% CI 6.513 - -2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable ( p = 0.519, 95% CI -1.605 - 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 hours (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. Conclusions: The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.

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