Abstract
Background and purpose: Intravenous thrombolytic therapy significantly improves the outcomes of acute ischemic stroke patients in a time-dependent manner. The aim of this study was to investigate whether continuous nursing quality improvement in stroke nurses has a positive effect on reducing the time to thrombolysis in acute ischemic stroke.Methods: The implementation of nursing quality improvement measures includes establishing full-time stroke nurses, pre-notification by emergency medical services (EMS), stroke team notification protocols, rapid triage, publicity and education, etc. Using a history-controlled approach, we analyzed acute ischemic stroke patients with intravenous thrombolysis during a pre-intervention period (April 1, 2015-July 31, 2016), trial period (August 1, 2016-October 31, 2016), and post-intervention period (November 1, 2016-September 30, 2017). This was done in accordance with the implementation of nursing quality improvement measures, including the general characteristics of the three groups, the time of each step in the process of thrombolysis, and the prognosis.Results: After the implementation of nursing quality improvement measures, the median door-to-needle time (DNT) was shortened from 73 min (interquartile range [IQR] 62–92 min) to 49 min (IQR 40-54 min; p < 0.001) in the post-intervention period. The median onset-to-needle time (ONT) was reduced from 193 min (IQR 155–240 min) to 167 min (IQR 125-227 min; p < 0.001). The proportion of patients with DNT ≤ 60 min increased from 23.94% (51/213) to 86.36% (190/220; p < 0.001) while the proportion of patients with DNT ≤ 40 min increased from 3.29% (7/213) to 25.00% (55/220; p < 0.001). The median time for door-to-laboratory results was decreased from 68 min to 56 min (p < 0.001). There was no significant difference in the fatality rate, 90-day modified Rankin score, length of stay or hospitalization expenses between the three groups of patients (p> 0.05).Conclusions: Implementation of nursing quality improvement measures in stroke nurses is an important factor in shortening the time of medication in patients with thrombolytic therapy, reducing the delay of intravenous thrombolysis in the hospital and helping to expedite presenting patients' arrival to the hospital post-stroke.
Highlights
Stroke has become the most frequent cause of death in China [1]
Pre-intervention Period vs. Post-intervention Period Compared to the pre-intervention period, door-to-needle time (DNT) and onset to needle time (ONT) both significantly decreased in the post-intervention period: 73 min vs. 49 min (p < 0.001) and 193 min vs. 167 min (p < 0.001), respectively
The percentage of DNT ≤ 60 min increased from 23.94 to 86.36% (p < 0.001) and DNT ≤ 40 min was increased from 3.29 to 25.00% (p < 0.001) after the nursing quality improvements
Summary
Stroke has become the most frequent cause of death in China [1]. The latest Ness-China (National Epidemiological Survey of the Stroke in China) study revealed that [2] the incidence of stroke in China is estimated at 274.4/100,000 [3], of which acute ischemic stroke (AIS) accounted for 60–80% of cases. Previous studies have reported the effectiveness of several strategies for reducing DNT times in acute ischemic stroke patients, including rapid triage, stroke team notification protocol, rapid laboratory testing, etc. To assure that more patients have timely thrombolytic therapy, the stroke center at the First Hospital of Jilin University implemented a series of measures to shorten the DNT, such as establishing full-time stroke nurses, pre-notification by emergency medical services (EMS), and stroke team notification protocol, rapid triage, rapid acquisition, and interpretation of brain imaging, etc. We found that the implementation of these nursing quality improvement measures resulted in substantial and positive effects on shortening the treatment process after AIS patients arrived at our hospital. Intravenous thrombolytic therapy significantly improves the outcomes of acute ischemic stroke patients in a time-dependent manner. The aim of this study was to investigate whether continuous nursing quality improvement in stroke nurses has a positive effect on reducing the time to thrombolysis in acute ischemic stroke
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