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Abstract
Background and Purpose: In acute stroke therapy, faster reperfusion leads to better outcome. We analyzed optimization steps to reduce treatment delays at a comprehensive stroke center in a non-academic tertiary hospital. Methods: Consecutive patients with ischemic stroke treated with either IV tPA, endovascular therapy or both were analyzed. Patient metrics were divided into two periods: pre-optimization period and post-optimization period. Key interventions of this workflow included: (1) addition of pre notification by EMS to ER and stroke team; (2) dividing stroke alert to level 1 (potential IV/IA candidate) vs. level 2; (3) direct transportation of level 1 stroke patients to brain CT imaging; (4) limitation of non-essential interventions; (5) 24/7 code stroke response by an in house trained vascular midlevel (NP/PA) and vascular neurologist (either in house or through telestroke network);(6) earlier notification of IR team; (7) CT to angiosuite direct transportation for LVO; (8) multidisciplinary monthly meetings to discuss delayed cases. Door to needle time and door to puncture time were used as target metrics in order to measure improvement. Results: A total of 279 patients were identified (101 in the pre-optimization and 178 in the post- optimization periods). No significant differences in any of the patient’s baseline characteristics were documented in the two observation periods. Almost all metrics favored the post-optimization period with a remarkable improvement in door to puncture time (64 (IQR 36-86) vs. 47 (IQR 20-62) min, p=0.002). Although non-statistically significant, we observed an increased percentage of good clinical outcomes in the post-optimization group (60.1% vs 54.8%, p=0.500). Conclusions: For patients undergoing acute reperfusion therapies, significant reductions in workflow time-frames can be achieved after simple optimization steps in a non-academic community based hospital.
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