Abstract TP391: Transition to a Single Dedicated Stroke Unit Improves Patient Satisfaction

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Patty Noah ◽  
Chris Hackett ◽  
Melanie Henderson ◽  
Leslie Pope ◽  
Vicki Cohen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Stroke Unit ◽  
Stroke Units ◽  
Assessment Scores ◽  
Care Assessment ◽  
The Press ◽  
Before And After ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year

Introduction: Dedicated inpatient stroke units have been shown to decrease mortality and improve clinical outcomes. There is scant data on patient satisfaction within dedicated stroke units or the perception of care reported by the patient. At a single comprehensive stroke center we recently consolidated two stroke units on different physical locations to a single dedicated stroke unit, located in close proximity to the neuro ICU. We assessed patient satisfaction before and after transitioning to a single dedicated stroke unit. Methods: We analyzed the Press Ganey survey overall satisfaction scores for one year preceding and one year following transition to a single dedicated stroke unit. The overall satisfaction score is rated on a likert scale from 0 - 100. We also analyzed subsection of the Press Ganey survey. An independent samples T-test statistical analysis was used to compare the data. Results: The unified stroke unit was opened on January 1, 2018. We evaluated 177 Press Ganey surveys in the year preceding the transition and 191 surveys in the year following the transition to a single dedicated stroke unit. The overall patient satisfaction was significantly higher in the year after transitioning to single dedicated stroke unit (mean 91.3, SD = 15.7) than in the year prior (mean 87.6, SD = 19.7), [ 95%CI 0.06 - 7.34], p = 0.05. Additionally, after moving the dedicated stroke unit patient care assessment scores in the stroke unit increased and variance decreased (mean 95.5, SD = 8.4) compared to the year prior (mean 85.1, SD = 25.4), although this difference was not statistically significant, p = 0.28. Conclusions: We found that transitioning to a single dedicated stroke unit significantly improved patient satisfaction scores and provided patients with more consistent care.

Abstract TP317: Utility and Cost of Inpatient Thrombophilia Testing in Ischemic Stroke Patients Aged 18-60

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Effrosyni Apostolidou ◽  
Priya Khatri ◽  
Eric Thomas ◽  
Sean Savitz ◽  
Alicia Zha
Keyword(s):  
Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Inpatient Setting ◽  
Initial Hospital ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year ◽  
Care Costs ◽  
Fvl Mutation

Introduction: Patients (pts) <60 years with ischemic stroke (IS) are commonly tested for thrombophilias (TP) due to the perception that there could be underlying hypercoagulable states. However, inherited TPs are largely not a risk factor for IS; and testing for acquired TPs in an acute inpatient setting may yield erroneous results that increase health care costs. We reviewed the frequency and cost of TP testing at our institution as part of a plan-do-study act cycle for improving the utilization of inpatient TP testing in young pts after IS. Methods: We performed a retrospective review of 18-60 year old pts admitted for IS to our comprehensive stroke center between 11/2016 and 7/2018. Pts discharged with a stroke etiology not attributed to large vessel (LV), small vessel (SV), or cardioembolic (CE) origin and the initial hospital TP testing monitored. Pts seen subsequently in clinic or later admissions in our system were monitored. Results: Of 1,162 pts, 104 without diagnosed LV/SV/CE etiologies were identified. At least one TP test was performed in 82 (79%) pts (Table 1). In 70 pts testing was done in the initial 24 hrs of hospitalization. One test abnormality was seen in 42 (51%) pts but anticoagulation was initiated in only one 1 patient at discharge. Forty-seven (45%) pts were followed in our outpatient clinic, with a mean follow up of 5 (0.2 – 24) months. TP was confirmed in 3 pts in clinic – two with heterozygous FVL mutation and one with known homozygous FVL mutation. The total charges of the initial inpatient testing is estimated to be as high as $222,150 for 82 patients. Conclusion: Frequent inpatient TP testing in young pts with cryptogenic stroke does not change management and can be costly to the hospital. Based on these results, we created a practice guideline to improve utilization of TP testing starting January 2019. A one year analysis of the effectiveness, safety, and cost for these changes is ongoing.

scholarly journals Relaciones entre laboratorios y medios de comunicación. Fármacos y enfermedades en la prensa: el caso de la disfunción eréctil, Viagra y Cialis = Relations between laboratories and media. Drugs and diseases in the press: the case of erectile dysfunction, Viagra and Cialis

2018 ◽  
Vol 9 (1) ◽  
pp. 32
Author(s):  
Ana Moreno Sesmero ◽  
Raquel Rodríguez Díaz
Keyword(s):  
Erectile Dysfunction ◽  
Agenda Setting ◽  
Major Interest ◽  
The Press ◽  
Before And After ◽  
The Media ◽  
One Year ◽  
Topic Tracking ◽  
Demand For Health ◽  
Medios De Comunicacion

Resumen: La preocupación por la salud por parte de los españoles se ha hecho un hueco entre las áreas con­sideradas de mayor interés para los ciudadanos. Este hecho se ha traducido, desde una perspecti­va mediática, en mayor presencia de información sanitaria en los medios. En esta línea, se presen­tan resultados de una investigación que analiza la influencia de los más destacados laboratorios de la industria farmacéutica (Pfizer y Lilly) en introducir en la agenda informativa sus productos y hacer de ellos un tema informativo relevante. El estudio de caso se centra en la disfunción eréctil, que entra en la agenda mediática motivado por el lanzamiento de sus principales fármacos: Viagra y Cialis. El estudio contempla un análisis de contenido en El País y en El Mundo durante el año previo y posterior al lanzamiento de Viagra y Cialis. Los resultados evidencian que un año antes de comercializarse la información sobre la disfunción eréctil era escasa, aumentando cuando la fecha de lanzamiento se aproximaba o ya estaba en el mercado.Palabras clave: Empresa farmacéutica; agenda mediática; agenda setting; gabinete de pren­sa; salud.Abstract:  The Spaniards’ concern about health has carved a niche among the areas considered of major interest to citizens. This increased demand for health information in the media has from a media perspective. In this line with this, we present the results of an investigation that analyzes the in­fluence of two of the leading laboratories in the Spanish pharmaceutical industry (Pfizer and Lilly) in introducing their commercial products in the news agenda and make them a relevant news topic. Tracking the case study focuses on erectile dysfunction, health aspect comes into the media agen­da driven by the launch of two of its major drugs: Viagra and Cialis. The study considers a content analysis in El País and El Mundo in the period before and after the launch of Viagra and Cialis. The results reveal that one year before the release of these products the information related to erectile dysfunction was scarce, it increased as the date of launch of the medicine approached or when it was being marketed.Keywords: Pharmaceutical company; media agenda; agenda setting; press office; health.

Abstract P149: Regional Transfer Protocols Can Improve Transfer Times and Reduce Length of Stay for Thrombectomy Candidates Seen on Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michele M Joseph ◽  
Amanda L Jagolino-Cole ◽  
Alyssa D Trevino ◽  
Liang Zhu ◽  
Alicia M Zha ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Rooms ◽  
Stroke Patients ◽  
Arrival Times ◽  
Time Periods ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year ◽  
The Impact ◽  
Transfer Times

Introduction: Our telestroke (TS) network instituted a regional transfer protocol (RTP) that allows for stroke patients in need of higher level of care to be pre-accepted and transferred to the nearest appropriate comprehensive stroke center (CSC). We studied the impact of the RTP on resource utilization and time metrics in patients transferred for evaluation of intra-arterial thrombectomy (IAT). Before the RTP, all potential IAT patients were transferred to one central CSC. After the RTP was initiated, the network had the capability to transfer to two additional CSCs within the same health system that are strategically located in the Houston area. Methods: We identified patients evaluated via TS in spoke emergency rooms that were subsequently transferred for IAT evaluation from 1/1/2016 to 12/31/2017 - one year prior and one year after the RTP. Baseline demographic characteristics, transfer and IAT metrics, and outcomes were compared for the two time periods. Results: Of 220 patients, 102 patients were transferred pre-RTP, and 120 were transferred to the three CSCs post-RTP. There were no significant differences in baseline characteristics, except fewer patients received tPA post-RTP (Table 1). In total, 30 patients (29%) pre-RTP and 42 patients (35%) post-RTP underwent IAT (p=0.38). Post-RTP, there was a trend toward faster travel times (median 40 vs 32 minutes, p=.07) and transfer initiation times to hub arrival times (median 109 vs 100.5 minutes, p=0.09). Door to groin puncture times were not statistically different between the two time periods. Post-RTP patients had a significantly shorter length of stay (median 6 vs 5 days, p=0.03). Conclusions: Regional transfer protocols can potentially help reduce transfer times and length of stay for stroke patients at CSCs that were initially seen by TS at community hospitals; however, larger sample size is needed to study its impact on other IAT-related metrics and clinical outcomes.

scholarly journals How a CT-Direct Protocol at an American Comprehensive Stroke Center Led to Door-to-Needle Times Less Than 30 Minutes

2016 ◽  
Vol 7 (2) ◽  
pp. 70-73 ◽  
Author(s):  
Lisa M. Caputo ◽  
Judd Jensen ◽  
Michelle Whaley ◽  
Mark J. Kozlowski ◽  
Christopher V. Fanale ◽  
...  
Keyword(s):  
Implementation Process ◽  
Evaluation Process ◽  
Protocol Implementation ◽  
Time Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Before And After ◽  
Symptomatic Intracranial Hemorrhage ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa

Background and Purpose: The safety and efficacy of intravenous tissue plasminogen activator (IV tPA) following acute ischemic stroke (AIS) is dependent on its timely administration. In 2014, our Comprehensive Stroke Center designed and implemented a computed tomography-Direct protocol to streamline the evaluation process of suspected patients with AIS, with the aim of reducing door-to-needle (DTN) times. The objectives of our study were to describe the protocol development and implementation process, and to compare DTN times and symptomatic intracranial hemorrhage (sICH) rates before and after protocol implementation. Methods: Data were prospectively collected for patients with AIS receiving IV tPA between January 1, 2010, and May 31, 2015. The DTN times, examined as median times and time treatment windows, and sICH rates were compared pre- and postimplementation. Results: Two hundred ninety-five patients were included in the study. After protocol implementation, median DTN times were significantly reduced (38 vs 28 minutes; P < .001). The distribution of patients treated in the three time treatment windows described below changed significantly, with an increase in patients with DTN times of 30 minutes or less, and a decrease in patients with DTN times 31 to 60 minutes and over 60 minutes ( P < .001). There were two cases of sICH prior to implementation and one sICH case postimplementation. Conclusions: The implementation of a protocol that streamlined the processing of suspected patients with AIS significantly reduced DTN time without negatively impacting patient safety.

Stroke Unit- / Stroke Center-Management

2021 ◽  
Vol 78 (6) ◽  
pp. 328-338
Author(s):  
Joachim Fladt ◽  
Stefan Engelter ◽  
Gian Marco De Marchis ◽  
Marios Psychogios ◽  
Philippe Lyrer ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Units ◽  
Stroke Center ◽  
Prävention Und Therapie

Zusammenfassung. In der Schweiz erleiden etwa 16’000 Menschen pro Jahr einen Hirnschlag. Für deren Behandlung stehen derzeit 23 Stroke Units und Stroke Center zur Verfügung. Die Akutbehandlung auf einer Stroke Unit folgt einem standardisierten, ganzheitlichen und interdisziplinären Ansatz, dessen Kernaufgaben die Prävention und Therapie von Akutkomplikationen, die Ursachenabklärung und Rezidivprophylaxe sowie die Frührehabilitation und Sozialplanung umfassen. Die Stroke Unit-Behandlung senkt die Mortalität und das Risiko bleibender Beeinträchtigungen nach einem Hirnschlag und ist neben der intravenösen Thrombolyse und der mechanischen Thrombektomie der Grundpfeiler der Hirnschlag-Akutbehandlung. Der folgende Artikel liefert einen detaillierten Überblick über die Kernaufgaben und aktuellen Behandlungsstandards des Stroke Unit-Managements.

scholarly journals First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

2016 ◽  
Vol 42 (5-6) ◽  
pp. 332-338 ◽  
Author(s):  
Iris Quasar Grunwald ◽  
Andreas Ragoschke-Schumm ◽  
Michael Kettner ◽  
Lenka Schwindling ◽  
Safwan Roumia ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Management ◽  
Imaging Evaluation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Stroke Imaging ◽  
Mobile Stroke Unit ◽  
Potential Benefits ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). Methods: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated. Results: Implementation of e-ASPECTS onto the MSU and into the prehospital stroke management was feasible. The values of e-ASPECTS matched with the results of conventional neuroradiologic analysis by the MSU team. The potential benefits of e-ASPECTS were illustrated by three cases. In case 1, excluding early infarct signs supported the decision to directly perform prehospital thrombolysis. In case 2, in which stroke was caused by large-vessel occlusion, the high e-ASPECTS value supported the decision to initiate intra-arterial treatment and triage the patient to a comprehensive stroke center. In case 3, the e-ASPECTS value was 10, indicating the absence of early infarct signs despite pre-existing cerebral microangiopathy and macroangiopathy, a finding indicating the program's robustness against artefacts. Conclusions: This study on the integration of e-ASPECTS into the prehospital stroke management via a MSU showed for the first time that such integration is feasible, and aids both decision regarding the treatment option and the triage regarding the most appropriate target hospital.

Abstract TMP10: Impact on Mechanical Thrombectomy Time Efficiencies Following Hospital Bypass Protocol Implementation: Northwest Ohio Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sharjeel Panjwani ◽  
Julie Shawver ◽  
Rami Abdelaziz ◽  
Gretchen Tietjen ◽  
Mouhammad Jumaa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Studies ◽  
Mechanical Thrombectomy ◽  
Arterial Occlusion ◽  
Before And After ◽  
Lucas County ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa ◽  
Early Stroke

Background: Early stroke identification and treatment with mechanical thrombectomy (MT) increases likelihood of favorable outcome. We compared our MT time efficiencies before and after Rapid Arterial oCclusion Evaluation Alert (RACE) bypass protocol (RA) implementation in Lucas County (LC) Ohio. Methods: Our RA protocol mandates emergent comprehensive stroke center transfer for patients with RACE score ≥ 5. We compared MT cases for RA patients (N=37) from Jul 2015-Jun 2016 with procedures performed on Stroke Alerts [(SA) N=56] from preceding 2 years. Transfers from outside LC, private transport and inhospital cases were excluded and only patients brought via LC-EMS were included in the analysis. Basic demographics, risk factors, 911 call to treatment, and outcomes were compared. Results: Treatment times including 911 call to IV tPA treatment, groin puncture, and recanalization were all significantly faster in the RA cohort (see graphic). Overall RA patients achieved recanalization and favorable outcomes at higher rate, although the latter was not statistically significant. Conclusion: Our experience indicates that RA protocol is highly effective in enhancing overall time efficiency for MT and may contribute to improved clinical outcomes. Further prospective studies are warranted.

Abstract WP68: Impact on ER Arrival & IV TPA Treatment Times Following Hospital Bypass Protocol Implementation: Northwest Ohio Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Julie Sahwver ◽  
Theodore Popa ◽  
Sharjeel Panjwani ◽  
Rami Abdelaziz ◽  
Gretchen Tietjen ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Treatment Time ◽  
Arterial Occlusion ◽  
Significant Delay ◽  
Protocol Implementation ◽  
Before And After ◽  
Lucas County ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa

Background: There is concern regarding hospital bypass stroke protocols potentially compromising IVtPA treatment due to transit time delay. We compared our IV thrombolysis time efficiencies before and after Rapid Arterial oCclusion Evaluation Alert (RACE) bypass protocol (RA) implementation in Lucas County (LC) Ohio. Methods: RA protocol whereby RACE score ≥5 patients are transferred directly to comprehensive stroke center (CSC) for potential mechanical thrombectomy (MT) was implemented in Jul 2015. All stroke alerts (SA) that required MT from July 2013 through June 2015 were compared to MT cases performed following RA protocol implementation. Transfers from other counties, private transport and in-hospital cases were excluded and only patients brought via LC-EMS were included in the analysis. Basic demographics, risk factors, 911 activation to treatment time, and outcomes were compared. Results: Between Jul 2015-Jun 2016, 37 RA patients underwent MT of which 21 (56.8%) were given IV tPA at the CSC. Whereas in the preceding 2 years from Jul 2013-Jun 2015, 56 SA patients underwent MT, of which 22 (39%) received IVtPA. Of these SA cases, 11 (50%) were drip and transfer from other LC ERs and the remaining 11 (50%) presented directly to CSC. The 911 activation to 1 st ER arrival remained unchanged (34 vs. 32 mins, p 0.4), whereas tPA administration was significantly faster (64 vs. 88 mins, p <0.05) in the RA cohort (see graphic). Conclusions: Within LC, the RA bypass protocol did not result in a significant delay to ER arrival and it significantly expedited IV tPA delivery to patients undergoing MT. Further prospective studies are warranted.

Abstract TP360: Triage Nursing Intervention Improves Stroke Treatment Rate and Times for Walk-In Strokes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nayive Quezada ◽  
Ron Burke ◽  
Yaima Miro Gonzalez ◽  
Maygret Ramirez ◽  
Ivis C Gonzalez ◽  
...  
Keyword(s):  
Rapid Assessment ◽  
Community Outreach ◽  
Nursing Intervention ◽  
Treatment Rate ◽  
Stroke Treatment ◽  
Response Team ◽  
Emergency Department Triage ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year

Introduction: Our comprehensive stroke center provides community outreach and stroke education to patients, caregivers, and community members on the importance of calling 911 in the event of a stroke. However, approximately 1/3 of our center’s stroke alerts are walk-ins. With a walk-in stroke, rapid assessment is essential because the stroke response team has no information compared to information that otherwise would be provided by EMS. As such, our center developed a rapid assessment by the emergency triage nurse or technician, who can then activate a stroke alert. Methods: The change to rapid stroke assessment and stroke alert activation by triage nurses and technicians (rather than waiting for an emergency physician to assess and activate a stroke alert) was made in March 2018. Cases from one year prior to the intervention were compared to cases from the year after implementation. Differences in turnaround times (door to stroke alert activation, door to needle [DTN]) were calculated. Results: In the period before implementation, there were 1200 stroke alerts, of which 420 arrived via triage (35%). Median door to stroke alert was 0 min. Of those who arrived through triage, 8 received IV alteplase (8/420=2%). For those patients, median DTN was 39 min. In contrast, after implementation, there were 1401 stroke alerts, of which 342 arrived via triage (24%). Median door to stroke alert was 2 min. Of those, 15 received IV alteplase (15/342=4%), with a median DTN of 32 min. Discussion: A nursing driven initiative at Emergency Department triage was effective at improving stroke treatment rate and decreasing DTN for IV alteplase for walk-in stroke patients.

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