Abstract WP346: Improving Nursing Skills In Acute Stroke Patients Can Reduce The Time-to-treatment

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
ESTELA SANJUAN ◽  
PILAR MELER ◽  
MARTA RUBIERA ◽  
MARC RIBO ◽  
MARIAN MUCHADA ◽  
...  
Keyword(s):  
Emergency Room ◽  
Acute Stroke ◽  
Blood Sample ◽  
Treatment Decision ◽  
Emergency Nursing ◽  
Sample Collection ◽  
Stroke Patients ◽  
Time To Treatment ◽  
Nursing Professionals ◽  
Mean Time

INTRODUCTION: Intravenous tPa treatment is time dependent. The management of Hypertension (HTN) and Hyperglycemia (HGL), along with blood sample collection in the emergency room (ER) may cause delays in tPa treatment, if not performed at the same time that the neurologist is examining the patient. Our aim was to determine whether the emergency nursing professional skills can reduce the delay on tPa administration during the emergency room stay. Methodology: This is a prospective study of acute stroke patients evaluated in the ER. Time from presentation to the ER to treatment was evaluated (time to treatment decision). This time was considered delayed if it was more than 40 minutes. Exact times of nursing activities were recorded as well as the causes that can impact delay and can be solved by nursing professionals (baseline hypertension, hyperglycemia and time to blood sample collection). Results: From January to July 2012, 222 patients were evaluated. 50% were men, mean age of 71,1 ,and mean time spent in the ER was 18±9 minutes. 35 patients where hypertensive on admission(15,8%), 59 had hyperglycemia(26,6%) and 11 had both(5%). Mean time to obtain blood sample was 5±3 minutes. Seventy-three patients(32,8%) were treated with intravenous tpa. Door-to-needle time was 39±19 minutes and CT-to-bolus time 11±4 minutes. In up to 29 times, a cause of delay in tPa initiation >40minutes was identified. Of those, 11 were related to nursing actions: 4(14,8%) blood sample delays and 7(25,9%) delays in treatment of HBP or HGL. Conclusions: Emergency nursing professionals have a very important role in acute stroke and developing skills and training may reduce time-to-treatment. A specialized stroke code nurse would probably improve stroke management in emergency room.

scholarly journals Improving the Evaluation of Collateral Circulation by Multiphase Computed Tomography Angiography in Acute Stroke Patients Treated with Endovascular Reperfusion Therapies

2016 ◽  
Vol 5 (3-4) ◽  
pp. 209-217 ◽  
Author(s):  
Alvaro García-Tornel ◽  
Vanessa Carvalho ◽  
Sandra Boned ◽  
Alan Flores ◽  
David Rodríguez-Luna ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Stroke ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Infarct Volume ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
The Mean ◽  
Mean Time

Good collateral circulation (CC) is associated with favorable outcomes in acute stroke, but the best technique to evaluate collaterals is controversial. Single-phase computed tomography angiography (sCTA) is widely used but lacks temporal resolution. We aim to compare CC evaluation by sCTA and multiphase CTA (mCTA) as predictors of outcome in endovascular treated patients. Methods: Consecutive endovascular treated patients with M1 middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion confirmed by sCTA were included. Two more CTA acquisitions with 8- and 16-second delays were performed for mCTA. Endovascular thrombectomy was performed independently of the CC status according to a local protocol [Alberta Stroke Program Early CT score (ASPECTS) >6, modified Rankin scale (mRS) score <3]. CC on sCTA and mCTA were compared. Results: 108 patients were included. Their mean age was 69.6 ± 13 years and their median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range 8). 79 (73.1%) had M1 MCA and 29 (26.9%) TICA occlusions. The mean time from symptom onset to CTA was 146.8 ± 96.5 min. On sCTA, 50.9% patients presented good CC vs. 57.5% on mCTA. Good CC status in both sCTA and mCTA had a lower 24-hour infarct volume (27.4 vs. 74.8 cm3 on sCTA, p = 0.04; 17.2 vs. 97.8 cm3 on mCTA, p < 0.01). However, only good CC on mCTA was associated with lower 24-hour (5 vs. 8.5, p = 0.04) and median discharge NIHSS (2 vs. 4.5, p = 0.04) scores and functional independency (mRS score <3) at 3 months (76.9 vs. 23.1%, p < 0.01). In a logistic regression model including age, NIHSS, ASPECTS and recanalization, only age (OR 0.96, 95% CI 0.93-0.99, p = 0.02) and good CC on mCTA (OR 5, 95% CI 1.99-12.6, p < 0.01) were independent predictors of functional outcome at 3 months. Conclusion: CC evaluation by mCTA is a better prognostic marker than CC evaluation by sCTA for clinical and functional endpoints in acute stroke patients treated with endovascular thrombectomy.

scholarly journals Practice Guideline Development for Referral Patients with Acute Stroke at Primary Level Hospital

2018 ◽  
Vol 16 (12) ◽  
pp. 921-930
Author(s):  
Arissara SUKWATJANEE
Keyword(s):  
Emergency Room ◽  
Acute Stroke ◽  
Practice Guideline ◽  
American Heart ◽  
Guideline Development ◽  
Healthcare Providers ◽  
Heart Association ◽  
Stroke Patients ◽  
Primary Level ◽  
Level Hospital

This action research aimed to develop a practice guideline for referral patients with acute stroke at a primary level hospital. Seventy two participants were healthcare providers working at an emergency room of the hospital. The participants were divided into 2 teams of developing and trying out the guideline by using the conduct and utilization of research in nursing model (CURN) as a conceptual framework. Descriptive statistics were used to assess the participants’ demographic characteristics including feasibility and possibility of using the guideline among the participants. Problems and obstacles of using the guideline were analyzed via content analysis. After 12 months of developing and trying out the guideline with acute stroke patients at an emergency room, the result revealed that time spent for referral of the patients was approximately 45 min reaching the standard of the American Heart Association. The recommendation was that this effective practical guideline could benefit referral patients with acute stroke at a primary level hospital.

scholarly journals Exclusive bed for thrombolysis. A simple measure that allows 85% of ischemic stroke patients to be treated in the first hour

2016 ◽  
Vol 74 (5) ◽  
pp. 373-375 ◽  
Author(s):  
Gabriella Tansini ◽  
Renata Dal-Prá Ducci ◽  
Edison Matos Nóvak ◽  
Francisco Manoel Branco Germiniani ◽  
Viviane Flumignan Zétola ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Emergency Room ◽  
General Hospital ◽  
Hospital Setting ◽  
Intravenous Thrombolysis ◽  
Important Goal ◽  
Stroke Patients ◽  
Time To Treatment ◽  
General Neurology ◽  
Simple Measure

ABSTRACT The door-to-needle time is an important goal to reduce the time to treatment in intravenous thrombolysis. Objective Analyze if the inclusion of an exclusive thrombolytic bed reduces the door-to-needle time. Method One hundred and fifty patients admitted for neurological evaluation with ischemic stroke were separated in two groups: in the first, patients were admitted in the Emergency Room for intravenous thrombolysis (ER Group); in the second, patients were admitted in an exclusive thrombolytic bed in the general neurology ward (TB Group). Results Sixty-eight (86.0%) patients from TB Group were treated in the first 60 minutes of arrival as compared to 48 (67.6%) in the ER Group (p = 0.011). Conclusion The introduction of a thrombolytic bed in a general hospital setting can markedly reduce the door-to-needle time, allowing more than 85% of patients to be treated within the first hour of admission.

Egyptian experience in increasing utilization of reperfusion therapies in acute ischemic stroke

2017 ◽  
Vol 13 (5) ◽  
pp. 525-529 ◽  
Author(s):  
Magd Fouad Zakaria ◽  
Hany Aref ◽  
Azza Abd ElNasser ◽  
Nagia Fahmy ◽  
Mohamed Amir Tork ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Action Plan ◽  
Treatment Decision ◽  
Reperfusion Therapy ◽  
Corrective Action ◽  
University Hospitals ◽  
Stroke Patients ◽  
And Training

Background The rate of alteplase (tPA) thrombolysis utilization in acute stroke in Egypt is <1%. We report on the causes of this low rate of reperfusion therapies and take corrective action to improve it. Methods Two prospective observational studies were conducted at Ain Shams University hospitals. The first included 269 acute stroke patients admitted to the hospital over a six-month period. Obstacles to reperfusion therapy were identified, and based on the results, a corrective action plan was implemented including making alteplase(tPA) available, training, and establishing a standardized local protocol for reperfusion therapy. A second study was then conducted that included 284 acute ischemic stroke patients over another six-month period. Results In the first study, 53/269 patients (19.7%) arrived at hospital within 4.5 h and were eligible for reperfusion therapy. Of those, seven (13.2%) received alteplase(tPA), representing 2.6% of the total ischemic stroke patients admitted. The main causes for not giving thrombolytic therapy was unavailability of alteplase(tPA) (56.5%), wrong treatment decision (17.4%), missed window while performing brain imaging (15%), and unavailability of intermediate care bed (10.9%). The second study showed that out of 284 cases admitted with acute ischemic stroke, 37 were eligible for thrombolysis and 35 received alteplase(tPA) (94.3%), representing 12.3% of the total ischemic stroke admissions. Conclusion A comprehensive action plan that centers around making the drug available and training resulted in a significant improvement of reperfusion therapy utilization in Egypt.

Spatial Analysis of Geographic Distribution and Accessibility of Suspected Acute Stroke Patients Transferred to Acute Stroke Centers by Emergency Medical Services in Tehran, Iran: A Cross-Sectional Study

2020 ◽  
Vol 22 (7) ◽  
Author(s):  
Pir-Hossein Kolivand ◽  
Hassanali Faraji Sabokbar ◽  
Peyman Saberian ◽  
Mahdi Bahmanabadi ◽  
Parisa Hasani-Sharamin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Cross Sectional Study ◽  
Time Of Arrival ◽  
Sectional Study ◽  
Stroke Patients ◽  
The West ◽  
Cross Sectional ◽  
The Mean ◽  
Stroke Center ◽  
Mean Time

Objectives: We intended to map the geographical distribution of patients with acute stroke who called the Tehran EMS center based on the geographic information of the incident location on a map. The distributions of these centers and patients’ access within a standard period were evaluated. Methods: A cross-sectional study based on the registered data was conducted on suspected acute stroke patients > 18 years of age that were transferred by EMS. The analysis was performed based on pointing the patients’ locations and locating the hospitals in ArcGIS software plus a review of the polygons and focal points. Results: Totally, 1,606 patients suspected to stroke with a mean age of 64.89 ± 17.48 years were evaluated, of whom 947 (58.6%) were male. The mean time of arrival of an ambulance in the patient’s location from the EMS station was 11.94 ± 6.67 minutes, and the longest time was 69.32 minutes. The mean time from the patient’s location to the stroke center was 17.79 ± 11.42 minutes (range 2.4 - 83.70 minutes). Stroke centers in Tehran are not distributed in a balanced manner, and they are concentrated on the central and northern parts of Tehran, limiting access to hospital services. Conclusions: The multiplicity of hospitals in the west and center of Tehran led to an increase in access times in eastern Tehran. It emphasizes the necessity of revision of service locating, especially because the east of Tehran has a denser texture than the west.

scholarly journals Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Tanya West ◽  
Julie Bernhardt
Keyword(s):  
Physical Activity ◽  
Acute Stroke ◽  
Medical Records ◽  
Stroke Unit ◽  
Prospective Observational Study ◽  
Activity Patterns ◽  
Models Of Care ◽  
Stroke Patients ◽  
Stroke Models ◽  
Mean Time

Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit.Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records.Results. On average, patients spent 45% (SD 25) of the day in some form of physical activity and received 58 (SD 34) minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32) hours post-stroke.Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care.

Abstract WP338: A Prospective Study of Post-thrombolysis related coagulopathy in Acute Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nicholas Osteraas ◽  
Shawna Cutting ◽  
Laurel Cherian ◽  
James Conners ◽  
Sarah Song ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Degradation Products ◽  
International Normalized Ratio ◽  
National Institutes Of Health ◽  
Mean Deviation ◽  
Stroke Patients ◽  
Patient Demographics ◽  
Intravenous Tissue Plasminogen Activator ◽  
A Prospective Study ◽  
Mean Time

Introduction: Although alterations in fibrinogen and fibrinogen degradation products are well-established after intravenous tissue plasminogen activator (IVtPA) in acute stroke, IVtPA is not recognized to cause markedly abnormal international normalized ratio (INR). Methods: With IRB approval, we prospectively screened 99 consecutive acute stroke patients who received IVtPA admitted from November 1, 2015 to July 1, 2016. Laboratory tests including INR, activated partial thromboplastin time (aPTT), fibrinogen, and d-Dimer were drawn at intervals of 6, 12, 24, and 48 hours. Data was collected on patient demographics, last known normal (LKN), IVtpA dose and timing, and National Institutes of Health Stroke Scale (NIHSS). Post-IVtPA coagulopathy was defined as INR ≥ 1.5. Reference range for fibrinogen was 190 - 395 mg/dL. Results: Among 44 patients prospectively enrolled, the mean age was 66.5 years (range, 32 to 91). Mean time from LKN to IVtPA administration was 2.6 hours (range 0.07 to 10.8). Initial pre-IVTPA mean NIHSS was 14 (range, 3 to 26) and 24 hour mean NIHSS was 7.4, (range 0 to 30). Mean pre-IVtPA INR was 1.05 (range, 0.9 to 1.4). Mean peak post-IVtPA INR was 1.28 (range 1.01 to 3.08). Mean deviation of actual to ideal IVtPA dose was 1.02 mg (range, 22.9 to 14.4). Post IVtPA coagulopathy occurred in 6 patients (14%), with peak INR noted at a mean of 13 hours after IVtPA administration (range, 5.6 to 18.6). Five patients of the six (83%) with post IVtPA coagulopathy had low fibrinogen, and mean fibrinogen nadir was 97 mg/dL (range, 37 to 242). Post-IVtPA coagulopathy was not significantly associated with initial NIHSS, 24 hour NIHSS, LKN to IVtPA time, or deviation of actual IVtPA dose from ideal dose. Conclusion: Post-IVtpA coagulopathy occurs in 14% of patients when studied prospectively and is associated with hypofibrinogenemia, but does not appear to correlate with severity of stroke or IVtPA dosing/timing.

Abstract WP253: Impact of a Stroke Coordinator on Improving Time to Treatment at Telestroke Sites.

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lidia B Yamada ◽  
Manuel C Gurry ◽  
Jillian B Harvey ◽  
Ellen Debenham ◽  
Christine A Holmstedt ◽  
...  
Keyword(s):  
South Carolina ◽  
Acute Stroke ◽  
Rural Areas ◽  
Multivariable Analysis ◽  
Categorical Variables ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Patient Age ◽  
Time To Treatment ◽  
Patient Âgé

Background: The implementation of Telestroke systems has made stroke expertise accessible to patients evaluated in hospitals located in rural areas. Yet, decreasing time from emergency department (ED) arrival to administration of intravenous tPA is still a challenge in many rural hospitals. Stroke coordinators can provide staff training on stroke recognition and implement strategies for faster assessment of acute stroke patients. We sought to determine if the presence of a stroke coordinator (SC) at Telestroke sites contributed to decreased door-to-registration (DTR) and door-to-needle (DTN) time in the ED. Methods: Data from Telestroke consultations at 22 different community hospitals in South Carolina (2008 - 2016) were analyzed. DTR and DTN were compared between consults when a SC was employed or not at the respective hospitals at the time of the consultation. T-tests and chi squared were used to examine differences in continuous and categorical variables, respectively. Estimates for each outcome were determined using a log link general linear model, with a gamma distribution, adjusting for patient age, sex, site, and stroke severity (NIH stroke scale) on admission. Results: Of 8441 Telestroke consultations performed, 5842 (69%) were included in the DTR analysis, with the remainder excluded due to incomplete data. DTN was available for 1056 consultations. Adjusted mean DTR time was 23.3 minutes shorter (31.6 vs. 54.9, p≤0.001) for consultations in sites that employ a SC vs. those without. Mean DTN time was 29.7 minutes shorter in sites with a SC (64.5 vs. 94.2, p≤0.001). The multivariable analysis showed that employment of a SC, site, patient age and NIHSS were significantly related to shorter DTR and DTN. Conclusions: Employment of a stroke coordinator at remote hospitals receiving Telestroke services can significantly decrease time to registration and time to treatment of patients presenting with acute stroke symptoms, which may improve outcomes for stroke patients.

scholarly journals Validation of a Dysphagia Screening Tool in Acute Stroke Patients

2010 ◽  
Vol 19 (4) ◽  
pp. 357-364 ◽  
Author(s):  
Jeff Edmiaston ◽  
Lisa Tabor Connor ◽  
Lynda Loehr ◽  
Abdullah Nassief
Keyword(s):  
Acute Stroke ◽  
Health Care Professionals ◽  
Screening Tool ◽  
Tertiary Care ◽  
Screening Tools ◽  
Care Hospital ◽  
Stroke Patients ◽  
Aspiration Risk ◽  
The Mean ◽  
Mean Time

Background Although many dysphagia screening tools exist, none has high sensitivity and reliability or can be administered quickly with minimal training. Objective To design and validate a swallowing screening tool to be used by health care professionals who are not speech language pathologists to identify dysphagia and aspiration risk in acute stroke patients. Methods In a prospective study of 300 patients admitted to the stroke service at an urban tertiary care hospital, interrater and test-retest reliabilities of a new tool (the Acute Stroke Dysphagia Screen) were established. The tool was administered by nursing staff when patients were admitted to the stroke unit. A speech language pathologist blinded to the results with the new tool administered the Mann Assessment of Swallowing Ability, a clinical bedside evaluation, with dysphagia operationally defined by a score less than 178. Results The mean time from admission to screening with the new tool was 8 hours. The mean time between administration of the new tool and the clinical bedside evaluation was 32 hours. For the new tool, interrater reliability was 93.6% and test-retest reliability was 92.5%. The new tool had a sensitivity of 91% and a specificity of 74% for detecting dysphagia and a sensitivity of 95% and a specificity of 68% for detecting aspiration risk. Conclusions The Acute Stroke Dysphagia Screen is an easily administered and reliable tool that has sufficient sensitivity to detect both dysphagia and aspiration risk in acute stroke patients.

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