Staff and Facility Utilization in Direct Patient Transfer to the Comprehensive Stroke Center: Testing a Real-Time Location System for Automatic Patient Pathway Characterization

Introduction: Starting reperfusion therapies as early as possible in acute ischemic strokes are of utmost importance to improve outcomes. The Comprehensive Stroke Centers (CSCs) can use surveys, shadowing personnel or perform journal analysis to improve logistics, which can be labor intensive, lack accuracy, and disturb the staff by requiring manual intervention. The aim of this study was to measure transport times, facility usage, and patient–staff colocalization with an automated real-time location system (RTLS).Patients and Methods: We tested IR detection of patient wristbands and staff badges in parallel with a period when the triage of stroke patients was changed from admission to the emergency room (ER) to direct admission to neuroradiology.Results: In total, 281 patients were enrolled. In 242/281 (86%) of cases, stroke patient logistics could be detected. Consistent patient–staff colocalizations were detected in 177/281 (63%) of cases. Bypassing the ER led to a significant decrease in median time neurologists spent with patients (from 15 to 9 min), but to an increase of the time nurses spent with patients (from 13 to 22 min; p = 0.036). Ischemic stroke patients used the most staff time (median 25 min) compared to hemorrhagic stroke patients (median 13 min) and stroke mimics (median 15 min).Discussion: Time spent with patients increased for nurses, but decreased for neurologists after direct triage to the CSC. While lower in-hospital transport times were detected, time spent in neuroradiology (CT room and waiting) remained unchanged.Conclusion: The RTLS could be used to measure the timestamps in stroke pathways and assist in staff allocation.

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Emergency Department Real-Time Location System Patient and Equipment Tracking

10.21236/ada555007 ◽

2011 ◽

Author(s):

Michael Mutter

Keyword(s):

Emergency Department ◽

Real Time ◽

Location System ◽

Real Time Location System

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Emergency Department Real Time Location System Patient and Equipment Tracking

10.21236/ada605020 ◽

2013 ◽

Author(s):

Michael Mutter

Keyword(s):

Emergency Department ◽

Real Time ◽

Location System ◽

Real Time Location System

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How do treatment times impact on functional outcome in stroke patients undergoing thrombectomy in Germany? Results from the German Stroke Registry

International Journal of Stroke ◽

10.1177/1747493020985260 ◽

2021 ◽

pp. 174749302098526

Author(s):

Juliane Herm ◽

Ludwig Schlemm ◽

Eberhard Siebert ◽

Georg Bohner ◽

Anna C Alegiani ◽

...

Keyword(s):

Functional Outcome ◽

Odds Ratio ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Stroke Registry ◽

Primary Stroke Center ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Center Time

Background Functional outcome post-stroke depends on time to recanalization. Effect of in-hospital delay may differ in patients directly admitted to a comprehensive stroke center and patients transferred via a primary stroke center. We analyzed the current door-to-groin time in Germany and explored its effect on functional outcome in a real-world setting. Methods Data were collected in 25 stroke centers in the German Stroke Registry-Endovascular Treatment a prospective, multicenter, observational registry study including stroke patients with large vessel occlusion. Functional outcome was assessed at three months by modified Rankin Scale. Association of door-to-groin time with outcome was calculated using binary logistic regression models. Results Out of 4340 patients, 56% were treated primarily in a comprehensive stroke center and 44% in a primary stroke center and then transferred to a comprehensive stroke center (“drip-and-ship” concept). Median onset-to-arrival at comprehensive stroke center time and door-to-groin time were 103 and 79 min in comprehensive stroke center patients and 225 and 44 min in primary stroke center patients. The odds ratio for poor functional outcome per hour of onset-to-arrival-at comprehensive stroke center time was 1.03 (95%CI 1.01–1.05) in comprehensive stroke center patients and 1.06 (95%CI 1.03–1.09) in primary stroke center patients. The odds ratio for poor functional outcome per hour of door-to-groin time was 1.30 (95%CI 1.16–1.46) in comprehensive stroke center patients and 1.04 (95%CI 0.89–1.21) in primary stroke center patients. Longer door-to-groin time in comprehensive stroke center patients was associated with admission on weekends (odds ratio 1.61; 95%CI 1.37–1.97) and during night time (odds ratio 1.52; 95%CI 1.27–1.82) and use of intravenous thrombolysis (odds ratio 1.28; 95%CI 1.08–1.50). Conclusion Door-to-groin time was especially relevant for outcome of comprehensive stroke center patients, whereas door-to-groin time was much shorter in primary stroke center patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03356392 . Unique identifier NCT03356392

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Abstract WP322: Inability to Identify Physician is Associated With Medication and Care Plan Knowledge Gaps Ii Stroke Patients

Stroke ◽

10.1161/str.47.suppl_1.wp322 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Fred Cohen ◽

Jeffrey M Katz ◽

Jackie McCarthy ◽

Ignacio Lopez ◽

Paul Wright

Keyword(s):

Medication Compliance ◽

Care Plan ◽

Medication Regimen ◽

Stroke Patients ◽

General Neurology ◽

Patient Dissatisfaction ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Knowledge Deficits ◽

Attending Physician

Introduction: Patient dissatisfaction and medication non-compliance correlate with patient misunderstanding of their medications and care plan. We aimed to assess the degree of these gaps and their associations in hospitalized stroke patients. Methods: A 5-question survey was administered to patients hospitalized on the neuroscience ward of a comprehensive stroke center. Patient understanding of their condition leading to admission, care plan, medications, primary attending physician, and follow-up plan was assessed. If the patient was unable to communicate, then their health care representative was interviewed. Results: A total of 146 patients (55 stroke and 91 general neurology and neurosurgery (non-stroke) patients) or their representatives were interviewed. Stroke patients were less likely to properly identify their primary attending physician (33/55 (60.0%) stroke patients versus 35/91 (38.5%) non-stroke patients; p=0.011). Inability to identify the attending physician was associated with lack of medication and care plan knowledge and was more common in stroke patients, (23/33 (69.7%) stroke patients versus 14/35 (40.0%) non-stroke patients; p=0.014). Conclusion: Despite sharing a common pool of providers, the inability to identify the primary attending physician was significantly more common in stroke patients and was associated with patient knowledge deficits regarding their medication regimen and care plan. This correlation was significantly higher in stroke patients and suggests that stroke patients may require different, extra or more robust communication and education than the general neurology and neurosurgery population. Additionally, emphasis on attending physician identification may improve patient satisfaction and medication compliance.

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Abstract 3313: Outcomes of “Drip-and-Ship” Paradigm Among Patients with Acute Ischemic Stroke. Results of a State Wide Study

Stroke ◽

10.1161/str.43.suppl_1.a3313 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Saqib A Chaudhry ◽

Gustavo J Rodriguez ◽

M. Fareed K Suri ◽

Adnan I Qureshi

Keyword(s):

Ischemic Stroke ◽

Recombinant Tissue Plasminogen Activator ◽

Population Based ◽

Primary Diagnosis ◽

Hospital Charges ◽

Stroke Patients ◽

Frequency Distributions ◽

Number Of Patients ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: “Drip-and-ship” denotes patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 hours to a comprehensive stroke center. Although drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population based level. Methods: State-wide estimates of thrombolysis, associated in-hospital outcomes and mortality were obtained from 2008-2009 Minnesota Hospital Association (MHA) data. Patient numbers and frequency distributions were calculated for state-wide sample of patients hospitalized with a primary diagnosis of ischemic stroke. Patients outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. Results: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n=473) or drip-and-ship paradigm (n=129). The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with drip-and-ship paradigm (8.5% versus 3.1, p=0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or drip-and-ship paradigm (5.9% versus 7.0%). The mean hospital charges were $65,669 for primary ED arrival and $47,850 for drip-and-ship treated patients (p<0.001). Conclusions: The results of drip-and-ship paradigm compare favorably with IV rt-PA treatment through primary ED arrival in this state-wide study.

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Abstract 83: Etiology of Late Right-to-Left Shunting on Transcranial Doppler in Ischemic Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.83 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adam de Havenon ◽

Anne Moore ◽

Nicholas Freeberg ◽

Ali Sultan-Qurraie ◽

David Tirschwell

Keyword(s):

Ischemic Stroke ◽

Transcranial Doppler ◽

Inclusion Criteria ◽

Contrast Injection ◽

Stroke Patients ◽

Stroke Etiology ◽

Standard Component ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Toast Classification

Background: An echocardiogram or transcranial Doppler (TCD) bubble study to test for a right-to-left shunt (RLS) is a standard component of an ischemic stroke workup. Because the pathway for an intracradiac RLS, such as a patent foramen ovale (PFO), is more direct, it has been proposed that the late appearance of a RLS suggests an extracardiac pathway. We sought to characterize a cohort of ischemic stroke patients with late RLS (LRLS) on TCD. Methods: We searched the medical record of a Comprehensive Stroke Center for patients with ischemic stroke who had a TCD and echocardiogram bubble study during 2011-2013. LRLS was defined as TCD bubbles appearing more than 18 cardiac cycles after contrast injection. TOAST stroke etiology classification was performed by a vascular neurologist blinded to TCD results. Results: 124 patients met inclusion criteria, of which 67/124 (54%) had RLS on TCD; and 32/67 (48%) had LRLS. In the 35/67 patients with normal RLS on TCD, 23% did not have RLS on echocardiography, consistent with prior reports of TCD’s superiority for detecting RLS. In the 32/67 patients with LRLS on TCD, 56% were negative for RLS by echocardiography. In the cohort of 124 patients, the percentage of TOAST classification 4 (stroke of other determined cause) was 26%, while in the 32 patients with LRLS the percentage of TOAST 4 was significantly higher at 52%(p=0.005) (Table 1). The increase in TOAST 4 in LRLS patients was created by an even distribution of decreases in the other TOAST categories. The most common TOAST 4 stroke etiology in LRLS patients was PFO with concurrent deep venous thrombosis. Conclusion: This preliminary data supports prior studies that have shown superiority of TCD over echocardiography for detection of RLS, and challenge the prevailing notion that extracardiac shunt, such as pulmonary AVM, is the most common cause of LRLS in ischemic stroke patients. This subgroup of patients warrants further research to clarify mechanisms of ischemic stroke in patients with RLS.

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