Abstract
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.
Highlights
Starting reperfusion therapies as early as possible in acute ischemic strokes are of utmost importance to improve outcomes
We hypothesized that: [1] primary stroke center (PSC) and emergency room (ER) bypass of patients with severe symptoms to a Comprehensive Stroke Centers (CSCs) would result in an increase of the time spent by medical staff with more severely disabled patients and [2] time patients spent at the neuroradiology department before a treatment decision for endovascular thrombectomy (EVT) was made would increase because initial medical assessment shifted from the ER to the neuroradiology unit
According to the previous local guidelines at our center, they were re-evaluated with native CT, multiphase CT angiography (CTA), CT perfusion (CTP), and discussed with the neurointerventionist before a decision was made for thrombectomy
Summary
Starting reperfusion therapies as early as possible in acute ischemic strokes are of utmost importance to improve outcomes. Bypass was initiated following teleconsultation between ambulance staff and a stroke physician at the Comprehensive Stroke Center (CSC) [5]. Those approved for PSC bypass was directly transferred from the ambulance to the CSC department of neuroradiology, bypassing the emergency room (ER), if cardiorespiratory stable and not unconscious [5]. We hypothesized that: [1] PSC and ER bypass of patients with severe symptoms to a CSC would result in an increase of the time spent by medical staff with more severely disabled patients (suspected to have large vessel occlusions) and [2] time patients spent at the neuroradiology department before a treatment decision for EVT was made would increase because initial medical assessment shifted from the ER to the neuroradiology unit. The impact of this study results could potentially be used for the changes in staffing and resource allocation
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