School of Medicine and Health Sciences Poster Presentations

Title

Reducing Resource Utilization and Improving Efficiency Using A Separate Activation for Emergent Large Vessel Occlusion Ischemic Strokes

Document Type

Poster

Keywords

stroke; quality; door-to-groin time; endovascular

Publication Date

Spring 2017

Abstract

Merrick Tan, Sandhya Patel, Eduard Shaykhinurov, Mary Cres Rodrigazo, Barbara Neiswander, Shahram Majidi, Kathleen Burger, Christopher R. Leon Guerrero

Reducing Resource Utilization and Improving Efficiency Using A Separate Activation for Emergent Large Vessel Occlusion Ischemic Strokes

OBJECTIVE

To improve the acute stroke management process in light of recent advancements in acute endovascular therapy.

BACKGROUND

Earlier treatment of acute ischemic stroke with both intravenous (IV) tPa and endovascular therapy results in better clinical outcomes. We performed a quality stream analysis (QSA) to develop an acute stroke management protocol to more efficiently deliver IV tPa and endovascular therapy.

DESIGN/METHODS

A process mapping QSA was designed and implemented to improve the acute stroke management process in light of the recent evidence supporting acute stroke intervention for large vessel occlusions. Major changes included (1) partitioning the work flow between cases requiring only IV tPA and probable cases for endovascular therapy (2) implementing a new separate activation system for probable large vessel occlusions - “LVO Attack” and (3) implementation of a door Straight-to-CT approach. Prior to the QSA all brain attack cases were reflexively getting a CTA head and neck to screen for LVO.

We compared outcomes between pre- and post-QSA epochs including door-to-tPA (DTT) time, door-to-groin (DTG) time, utilization of any vascular imaging during hospitalization (i.e. CTA, MRA, IR, or carotid ultrasound), and symptomatic hemorrhagic transformation. Non-parametric statistics were used with p<0.05 required for significance.

RESULTS

A total of 215 patients were included (97 in the pre- and 108 in the post-improvement epoch). Median DTT time improved (57 to 27 min, p=0.013). There was a trend towards shorter median DTG time in the post- compared to pre-QSA, however, the difference was not statistically significant (131 to 65 min, p=0.51). There was a 39.8% absolute reduction in vascular imaging. There was no difference in symptomatic hemorrhagic transformation between the two epochs.

CONCLUSIONS

Partitioning of the acute stroke management process with a separate activation for probable large vessel occlusions resulted in a reduction of vascular imaging utilization and did not result in slower door-to-groin times.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

1

Comments

Poster to be presented at GW Annual Research Days 2017.

This document is currently not available here.

Share

COinS
 

Reducing Resource Utilization and Improving Efficiency Using A Separate Activation for Emergent Large Vessel Occlusion Ischemic Strokes

Merrick Tan, Sandhya Patel, Eduard Shaykhinurov, Mary Cres Rodrigazo, Barbara Neiswander, Shahram Majidi, Kathleen Burger, Christopher R. Leon Guerrero

Reducing Resource Utilization and Improving Efficiency Using A Separate Activation for Emergent Large Vessel Occlusion Ischemic Strokes

OBJECTIVE

To improve the acute stroke management process in light of recent advancements in acute endovascular therapy.

BACKGROUND

Earlier treatment of acute ischemic stroke with both intravenous (IV) tPa and endovascular therapy results in better clinical outcomes. We performed a quality stream analysis (QSA) to develop an acute stroke management protocol to more efficiently deliver IV tPa and endovascular therapy.

DESIGN/METHODS

A process mapping QSA was designed and implemented to improve the acute stroke management process in light of the recent evidence supporting acute stroke intervention for large vessel occlusions. Major changes included (1) partitioning the work flow between cases requiring only IV tPA and probable cases for endovascular therapy (2) implementing a new separate activation system for probable large vessel occlusions - “LVO Attack” and (3) implementation of a door Straight-to-CT approach. Prior to the QSA all brain attack cases were reflexively getting a CTA head and neck to screen for LVO.

We compared outcomes between pre- and post-QSA epochs including door-to-tPA (DTT) time, door-to-groin (DTG) time, utilization of any vascular imaging during hospitalization (i.e. CTA, MRA, IR, or carotid ultrasound), and symptomatic hemorrhagic transformation. Non-parametric statistics were used with p<0.05 required for significance.

RESULTS

A total of 215 patients were included (97 in the pre- and 108 in the post-improvement epoch). Median DTT time improved (57 to 27 min, p=0.013). There was a trend towards shorter median DTG time in the post- compared to pre-QSA, however, the difference was not statistically significant (131 to 65 min, p=0.51). There was a 39.8% absolute reduction in vascular imaging. There was no difference in symptomatic hemorrhagic transformation between the two epochs.

CONCLUSIONS

Partitioning of the acute stroke management process with a separate activation for probable large vessel occlusions resulted in a reduction of vascular imaging utilization and did not result in slower door-to-groin times.