Improving treatment times for patients with in-hospital stroke using a standardized protocol

J Neurol Sci. 2017 Oct 15:381:68-73. doi: 10.1016/j.jns.2017.08.023. Epub 2017 Aug 18.

Abstract

Background: Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol.

Methods: Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008-March 2014) and after implementation (April 2014-December 2016).

Results: Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5min, p<0.01) and to first neuroimaging (50 vs. 26.5min, p<0.01) and in the median time from first neuroimaging to intravenous thrombolysis (45 vs. 16min, p=0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53min, p=0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0-2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods.

Conclusion: Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety.

Keywords: Endovascular therapy; In-hospital stroke; Stroke protocol; Thrombolysis.

MeSH terms

  • Administration, Intravenous
  • Aged
  • Clinical Protocols* / standards
  • Endovascular Procedures
  • Female
  • Health Personnel / education
  • Hospitalization*
  • Humans
  • Male
  • Neuroimaging
  • Quality Improvement*
  • Retrospective Studies
  • Stroke / diagnostic imaging
  • Stroke / therapy*
  • Thrombolytic Therapy
  • Time-to-Treatment*
  • Treatment Outcome