Abstract WP330: Process Measures and Outcomes in Defuse 3 Trial by Day and Week Time Patterns

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Mlynash ◽  
Maarten G Lansberg ◽  
Stephanie Kemp ◽  
Soren Christensen ◽  
Michael P Marks ◽  
...  
Keyword(s):  
Arrival Time ◽  
Stroke Care ◽  
Mortality Rates ◽  
Temporal Variations ◽  
Time Of Day ◽  
Process Measures ◽  
Time Period ◽  
Time Patterns ◽  
Time Of Admission

Introduction: Several studies identified temporal variations in stroke care and suggested that quality of care declines during off-hours and on weekends. Methods: We specified 2 time definitions: a) 8-hour blocks: night (midnight – 7:59), day (8:00 – 15:59), evening (16:00-23:59); b) weekday vs. weekend. We compared process measures and outcomes of the EVT-treated DEFUSE 3 patients based on these definitions. To assign patients to time-blocks, we used date and time of admission to hospital that performed EVT. Results: 92 patients were randomized to EVT treatment: 30% arrived to the treating hospital at night, 49% at day, 21% at evening. Mean age by arrival time 71±14, 70±12, 63±15 (p=0.09); NIHSS 17±5, 15±6, 15±8 (p=0.40); female 39%, 51%, 63% (p=0.27). Weekend admission occurred in 21%. Weekday vs weekend mean age 68±14 vs 72±11 (p=0.19); female 53% vs 37% (p=0.20), higher weekend NIHSS 15±6 vs 18±6 (p=0.04). Onset to arrival at the EVT center varied by time of day: (hrs:mins) 7:04±2:43 night, 8:05±3:01 day, 4:51±2:30 evening, p<0.001. However, day admissions tended to be wake-up/not witnessed strokes more often: 76% vs. 47% evening and 64% night, p=0.09. Transfer times for 57 transfer patients were similar: mean 3:06, 3:09, 3:38. Time from arrival at the treating hospital to groin puncture varied by presenting times: 2:28±1:11 night, 1:45±0:46 day, 2:36±2:32 evening (p=0.02). Time-metrics for weekday vs weekend were similar. Rates of successful reperfusion, 90-day mRS and mRS=0-2 did not differ by time of day or week. There was higher 90-day mortality (32% vs 10%, p=0.02) and in-hospital mortality (21% vs. 4%, p=0.03) on weekend. Symptomatic ICH also occurred more commonly in weekend admits (21% vs 3%, p=0.01). However, after adjustment for age and NIHSS, presenting on weekend was not independently associated with mortality, p=0.13. Conclusions: DEFUSE 3 patients admitted during the day had the longest time from last known well to arrival at the study site due to the high percentage of wake-up strokes admitted during this time period, however, these patients had the shortest arrival to groin puncture times. Although mortality rates were higher for patients who presented on weekends, this may be explained by the fact that these patients were older and had higher NIHSS.

scholarly journals Temporal variations in quality of acute stroke care and outcomes in London hyperacute stroke units: a mixed-methods study

2020 ◽  
Vol 8 (34) ◽  
pp. 1-98
Author(s):  
Robert Simister ◽  
Georgia B Black ◽  
Mariya Melnychuk ◽  
Angus IG Ramsay ◽  
Abigail Baim-Lance ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Acute Stroke ◽  
Stroke Care ◽  
National Audit ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Hyperacute Stroke ◽  
Factors Influencing ◽  
Time Of Admission

Background Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of the day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units. Objectives To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units, and to identify factors influencing such variations. Design This was a prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme. Factors influencing variations in care and outcomes were studied through interview and observation data. Setting The setting was acute stroke services in London hyperacute stroke units. Participants A total of 7094 patients with a primary diagnosis of stroke took part. We interviewed hyperacute stroke unit staff (n = 76), including doctors, nurses, therapists and administrators, and 31 patients and carers. We also conducted non-participant observations of delivery of care at different times of the day and week (n = 45, ≈102 hours). Intervention Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards was designed to deliver uniform access to high-quality hyperacute stroke unit care across the week. Main outcome measures Indicators of quality of acute stroke care, mortality at 3 days after admission, disability at the end of the inpatient spell and length of stay. Data sources Sentinel Stroke National Audit Programme data for all patients in London hyperacute stroke units with a primary diagnosis of stroke between 1 January and 31 December 2014, and nurse staffing data for all eight London hyperacute stroke units for the same period. Results We found no variation in quality of care by day and time of admission across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor in 3-day mortality nor disability at hospital discharge. Other quality-of-care measures significantly varied by day and time of admission. Quality of care was better if the nurse in charge was at a higher band and/or there were more nurses on duty. Staff deliver ‘front-door’ interventions consistently by taking on additional responsibilities out of hours, creating continuities between day and night, building trusting relationships and prioritising ‘front-door’ interventions. Limitations We were unable to measure long-term outcomes as our request to the Sentinel Stroke National Audit Programme, the Healthcare Quality Improvement Partnership and NHS Digital for Sentinel Stroke National Audit Programme data linked with patient mortality status was not fulfilled. Conclusions Organisational factors influence 24 hours a day, 7 days a week (24/7), provision of stroke care, creating temporal patterns of provision reflected in patient outcomes, including mortality, length of stay and functional independence. Future work Further research would help to explore 24/7 stroke systems in other contexts. We need a clearer understanding of variations by looking at absolute time intervals, rather than achievement of targets. Research is needed with longer-term mortality and modified Rankin Scale data, and a more meaningful range of outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 34. See the NIHR Journals Library website for further project information.

scholarly journals Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e025366 ◽  
Author(s):  
Mariya Melnychuk ◽  
Stephen Morris ◽  
Georgia Black ◽  
Angus I G Ramsay ◽  
Jeannie Eng ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Performance Standards ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
P Values ◽  
Stroke Units ◽  
Hyperacute Stroke ◽  
Time Of Admission

ObjectiveTo investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units compared with the rest of England.DesignProspective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme.SettingAcute stroke services in London hyperacute stroke units and the rest of England.Participants68 239 patients with a primary diagnosis of stroke admitted between January and December 2014.InterventionsHub-and-spoke model for care of suspected acute stroke patients in London with performance standards designed to deliver uniform access to high-quality hyperacute stroke unit care across the week.Main outcome measures16 indicators of quality of acute stroke care, mortality at 3 days after admission to the hospital, disability at the end of the inpatient spell, length of stay.ResultsThere was no variation in quality of care by day and time of admission to the hospital across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor was there variation in 3-day mortality or disability at hospital discharge (all p values>0.05). Other quality of care measures significantly varied by day and time of admission across the week in London (all p values<0.01). In the rest of England there was variation in all measures by day and time of admission across the week (all p values<0.01), except for mortality at 3 days (p value>0.05).ConclusionsThe London hyperacute stroke unit model achieved performance standards for ‘front door’ stroke care across the week. The same benefits were not achieved by other models of care in the rest of England. There was no weekend effect for mortality in London or the rest of the England. Other aspects of care were not constant across the week in London hyperacute stroke units, indicating some performance standards were perceived to be more important than others.

scholarly journals Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

2021 ◽  
Author(s):  
Neda Ghadimi ◽  
Nasrin Hanifi ◽  
Mohammadreza Dinmohammadi
Keyword(s):  
Medical Service ◽  
Arrival Time ◽  
Treatment Time ◽  
Stroke Care ◽  
Mortality Rates ◽  
National Institutes Of Health ◽  
Critical Factors ◽  
Time To Treatment ◽  
Factors Influencing ◽  
Maximum Delay

Abstract Background: The results of acute ischemic stroke (AIS) are highly affected by time-to-treatment. This study aimed at determining the factors influencing the in-hospital and pre-hospital delays in the complications and time-to-treatment in AIS. Methods: The present prospective study was carried out on 204 AIS patients referring to the stroke care unit in Zanjan, Iran (2019). To collected the required data, the patients and families were interviewed, as well as using the observations and records. The complication and mortality rates were recorded for 30 days after stroke via call follow-ups. Results: Based on the obtained results, the maximum delay was associated with the onset-to-arrival time (288.19 ±339.02 minutes). The logistic regression results indicated a statistically significant decline in the treatment via consultation after initiating the symptoms, transferring the patient to the hospital via emergency medical service, and the patients’ comprehension regarding the AIS symptoms. It was also found that an increase in the onset-to-treatment time (P <.001) and higher National Institutes of Health Stroke Scale (NIHSS) scores (P< .001) are the most critical factors related to the post-stroke complications. The higher age (P <.044) and NIHSS scores (P < .001) were considerably related to the mortality in AIS patients. Conclusion: It is essential to inform people regarding AIS indicators and referring to AIS treatment units to reduce the treatment time.

The ENT emergency clinic: does senior input matter?

2012 ◽  
Vol 127 (1) ◽  
pp. 15-19 ◽  
Author(s):  
A Mirza ◽  
L McClelland ◽  
M Daniel ◽  
N Jones
Keyword(s):  
Quality Of Care ◽  
Discharge Rate ◽  
Surrogate Marker ◽  
Operating Theatre ◽  
Number Of Children ◽  
Discharge Rates ◽  
Time Period ◽  
Number Of Patients

AbstractBackground:Many ENT conditions can be treated in the emergency clinic on an ambulatory basis. Our clinic traditionally had been run by foundation year two and specialty trainee doctors (period one). However, with perceived increasing inexperience, a dedicated registrar was assigned to support the clinic (period two). This study compared admission and discharge rates for periods one and two to assess if greater registrar input affected discharge rate; an increase in discharge rate was used as a surrogate marker of efficiency.Method:Data was collected prospectively for patients seen in the ENT emergency clinic between 1 August 2009 and 31 July 2011. Time period one included data from patients seen between 1 August 2009 and 31 July 2010, and time period two included data collected between 1 August 2010 and 31 July 2011.Results:The introduction of greater registrar support increased the number of patients that were discharged, and led to a reduction in the number of children requiring the operating theatre.Conclusion:The findings, which were determined using clinic outcomes as markers of the quality of care, highlighted the benefits of increasing senior input within the ENT emergency clinic.

scholarly journals Detecting Tourism Typologies of Regional Destinations Based on Their Spatio-Temporal and Socioeconomic Performance: A Correlation-Based Complex Network Approach for the Case of Greece

2021 ◽  
Vol 2 (1) ◽  
pp. 113-139
Author(s):  
Dimitrios Tsiotas ◽  
Thomas Krabokoukis ◽  
Serafeim Polyzos
Keyword(s):  
Network Analysis ◽  
Complex Network ◽  
Community Detection ◽  
Optimization Algorithm ◽  
Spatial Dimension ◽  
Economic Dimension ◽  
Complex Network Analysis ◽  
Time Period ◽  
Time Patterns ◽  
Spatio Temporal

Within the context that tourism-seasonality is a composite phenomenon described by temporal, geographical, and socio-economic aspects, this article develops a multilevel method for studying time patterns of tourism-seasonality in conjunction with its spatial dimension and socio-economic dimension. The study aims to classify the temporal patterns of seasonality into regional groups and to configure distinguishable seasonal profiles facilitating tourism policy and development. The study applies a multilevel pattern recognition approach incorporating time-series assessment, correlation, and complex network analysis based on community detection with the use of the modularity optimization algorithm, on data of overnight-stays recorded for the time-period 1998–2018. The analysis reveals four groups of seasonality, which are described by distinct seasonal, geographical, and socio-economic profiles. Overall, the analysis supports multidisciplinary and synthetic research in the modeling of tourism research and promotes complex network analysis in the study of socio-economic systems, by providing insights into the physical conceptualization that the community detection based on the modularity optimization algorithm can enjoy to the real-world applications.

Age-Related Disparities in the Quality of Stroke Care and Outcomes in Rehabilitation Hospitals: The Australian National Audit

2021 ◽  
Vol 30 (5) ◽  
pp. 105707
Author(s):  
Tara Purvis ◽  
Isobel J Hubbard ◽  
Dominique A Cadilhac ◽  
Kelvin Hill ◽  
Justine Watkins ◽  
...  
Keyword(s):  
Stroke Care ◽  
National Audit ◽  
Age Related ◽  
Rehabilitation Hospitals

scholarly journals Quality of HIV Care and Mortality Rates in HIV-Infected Patients

2015 ◽  
Vol 62 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Philip Todd Korthuis ◽  
Kathleen A. McGinnis ◽  
Kevin L. Kraemer ◽  
Adam J. Gordon ◽  
Melissa Skanderson ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Hiv Care

FP22-TU-01 Quality of acute stroke care in Thailand, a prospective multicenter countrywide study

2009 ◽  
Vol 285 ◽  
pp. S91
Author(s):  
Y. Nilanont ◽  
S. Nidhinandana ◽  
N. Suwanwela ◽  
N. Poungvarin
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care

scholarly journals Do Guidelines for the Diagnosis and Monitoring of Diabetes Mellitus Fulfill the Criteria of Evidence-Based Guideline Development?

2008 ◽  
Vol 54 (11) ◽  
pp. 1872-1882 ◽  
Author(s):  
Eva Nagy ◽  
Joseph Watine ◽  
Peter S Bunting ◽  
Rita Onody ◽  
Wytze P Oosterhuis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Methodological Quality ◽  
Guideline Development ◽  
Evidence Based ◽  
Test Results ◽  
Time Period ◽  
Therapeutic Guidelines ◽  
Therapeutic Recommendations ◽  
Evidence Based Guideline

Abstract Background: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. Methods: After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. Results: The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. Conclusions: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine.

Assessing The Quality of Water Depth Derived From Volunteered Geographic Information (VGI) For Flood Monitoring. A Case Study of Hurricane Harvey In Harris County, Texas

2021 ◽  
Author(s):  
Abdullatif Alyaqout ◽  
T. Edwin Chow ◽  
Alexander Savelyev
Keyword(s):  
Water Depth ◽  
Temporal Distribution ◽  
Volunteered Geographic Information ◽  
Temporal Variations ◽  
Geographic Information ◽  
Text Messages ◽  
Quality Of Water ◽  
Significant Difference ◽  
Flood Monitoring

Abstract The primary objectives of this study are to 1) assess the quality of each volunteered geographic information (VGI) data modality (text, pictures, and videos), and 2) evaluate the quality of multiple VGI data sources, especially the multimedia that include pictures and videos, against synthesized water depth (WD) derived from remote sensing (RS) and authoritative data (e.g. stream gauges and depth grids). The availability of VGI, such as social media and crowdsourced data, empowered the researchers to monitor and model floods in near-real-time by integrating multi-sourced data available. Nevertheless, the quality of VGI sources and its reliability for flood monitoring (e.g. WD) is not well understood and validated by empirical data. Moreover, existing literature focuses mostly on text messages but not the multimedia nature of VGI. Therefore, this study measures the differences in synthesized WD from VGI modalities in terms of (1) spatial and (2) temporal variations, (3) against WD derived from RS, and (4) against authoritative data including (a) stream gauges and (b) depth grids. The results of the study show that there are significant differences in terms of spatial and temporal distribution of VGI modalities. Regarding VGI and RS comparison, the results show that there is a significant difference in WD between VGI and RS. In terms of VGI and authoritative data comparison, the analysis revealed that there is no significant difference in WD between VGI and stream gauges, while there is a significant difference between the depth grids and VGI.

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