Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF)

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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Basic Clinical Syndromes and Definitions

Acute Stroke Management in the First 24 Hours ◽

10.1093/med/9780190856519.003.0001 ◽

2018 ◽

pp. 1-21

Author(s):

Aparna Pendurthi ◽

Maxim Mokin

Keyword(s):

Emergency Department ◽

Acute Stroke ◽

Clinical Characteristics ◽

Clinical Presentation ◽

Clinical Manifestations ◽

Transient Ischemic Attacks ◽

Stroke Patients ◽

Duration Of Symptoms ◽

Surgical Interventions ◽

Clinical Syndromes

The goal for neurological evaluation in the Emergency Department is to appropriately route potential acute stroke patients toward medical or surgical interventions in the most expedient manner possible. This chapter focuses on familiarizing the reader with main stroke subtypes and clinical manifestations associated with specific syndromes. Acute neurologic episodes being evaluated in the emergent setting for stroke workup can be divided into broad categories based on duration of symptoms, clinical presentation, and findings from basic imaging. This chapter explores the most common of these stroke syndromes and discusses the classification and clinical characteristics of transient ischemic attacks and ischemic and hemorrhagic strokes.

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Factors associated with late arrival of acute stroke patients to emergency department in Saudi Arabia

SAGE Open Medicine ◽

10.1177/2050312118776719 ◽

2018 ◽

Vol 6 ◽

pp. 205031211877671 ◽

Cited By ~ 4

Author(s):

Ali M Al Khathaami ◽

Yasmeen O Mohammad ◽

Fatimah S Alibrahim ◽

Hoda A Jradi

Keyword(s):

Emergency Department ◽

Saudi Arabia ◽

Acute Stroke ◽

Delayed Presentation ◽

Stroke Patients ◽

Cross Sectional Survey ◽

Community Based Interventions ◽

Cross Sectional ◽

Factors Associated ◽

Late Arrival

Background: Tissue plasminogen activator within 4.5 h of onset is effective for acute ischemic stroke. However, only small proportion of patients is treated due to delayed presentation. We aimed to examine the factors associated with delays of stroke patients in Riyadh, Saudi Arabia. Methods: A cross-sectional survey was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, during a 6-month period. An interviewer administered structured questionnaire addressed to the acute stroke patients or their relatives was used to explore the factors associated with delayed arrival. Results: A total of 227 patients attending the emergency department were interviewed. The mean age was 60.4 ± 15.6 years. Approximately 56.4% presented after 4.5 h of stroke onset. Factors associated with late arrival were being alone during the onset of stroke, not being transported in an ambulance, not knowing that they were experiencing a stroke, and residing outside the city of Riyadh. Conclusion: More than half of patients missed the golden hours for thrombolysis due to delayed presentation. Reasons include lack of knowledge, underuse of ambulance and difficult access to care. Urgent community-based interventions are needed to address these factors.

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A prognostic role for Low tri-iodothyronine syndrome in acute stroke patients: A systematic review and meta-analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2018.03.025 ◽

2018 ◽

Vol 169 ◽

pp. 55-63 ◽

Cited By ~ 10

Author(s):

Nayan Lamba ◽

Chunming Liu ◽

Hasan Zaidi ◽

M.L.D. Broekman ◽

Thomas Simjian ◽

...

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Meta Analysis ◽

Prognostic Role ◽

Stroke Patients

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Postthrombolysis Intracranial Hemorrhage Risk of Cerebral Microbleeds in Acute Stroke Patients: A Systematic Review and Meta-Analysis

International Journal of Stroke ◽

10.1111/j.1747-4949.2012.00869.x ◽

2012 ◽

Vol 8 (5) ◽

pp. 348-356 ◽

Cited By ~ 60

Author(s):

Ashkan Shoamanesh ◽

Chun Shing Kwok ◽

Patricia Annabelle Lim ◽

Oscar R. Benavente

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Intracranial Hemorrhage ◽

Meta Analysis ◽

Cerebral Microbleeds ◽

Stroke Patients ◽

Hemorrhage Risk

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Pharmacists as Care Providers for Stroke Patients: A Systematic Review

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

10.1017/cjn.2017.233 ◽

2017 ◽

Vol 45 (1) ◽

pp. 49-55 ◽

Cited By ~ 7

Author(s):

Jade E. Basaraba ◽

Michelle Picard ◽

Kirsten George-Phillips ◽

Tania Mysak

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Acute Stroke ◽

Patient Care ◽

Patient Outcomes ◽

Stroke Patient ◽

Full Text ◽

Stroke Patients ◽

Pharmacist Interventions ◽

The Impact

AbstractBackground:Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes.Methods: Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed.Results: A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life.Conclusions: Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team.

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Dysphagia screening tools for acute stroke patients available for nurses: A systematic review

Nursing Practice Today ◽

10.18502/npt.v6i3.1253 ◽

2019 ◽

Author(s):

Isabel de Jesus Oliveira ◽

Liliana Andreia Neves Da Mota ◽

Susana Vaz Freitas ◽

Pedro Lopes Ferreira

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Methodological Quality ◽

Selection Index ◽

Significant Proportion ◽

Screening Tools ◽

Quality Analysis ◽

Diagnostic Process ◽

Index Test ◽

Stroke Patients

Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses? Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion. Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable. Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.

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