Abstract
Background: Early endovascular recanalization of occluded vessels in acute ischemic stroke (AIS) is a major contributor to good clinical outcome. We report the analysis of all AIS patients throughout a 6-year experience following the deployment of a quality initiative aiming at improving care, speed and maintaining quality for AIS treatment.Methods: Using a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2017, workflow/outcomes were recorded. There were no exclusion criteria. During the first year, a quality program employing “digital-object” technology, staff education, and workflow improvement was implemented to reduce time-to-treatment. Using electronic recording, workflow times were collected for onset (TO), CT (TCT), door (TD), angiography-suite (TA), groin puncture (TG), DSA (TDSA), and recanalization (TR). Recanalization time (TG-TR) and workflow intervals were compared at Year 1 and 6.Results: Analysis of 382 patients (aged 71.3 ± 12.9) undergoing mechanical thrombectomy for AIS (206 male and 176 female) was performed. Recanalization time was significantly reduced from 82 min in 2012 to 34 min by 2017 (IQR 52–117 min and 23–49 min), a 59% reduction (P < 0.001). Further, consistent year-over-year reductions in setup time (TA-TG) (44% improvement) and TCT to TA times were observed. During the same period, clinical outcome significantly improved year-over-year as measured with the modified Rankin Scale 0–2 (33, 37, 38, 41, 53, and 58%).Conclusions: Significant improvements were observed following the deployment of a quality initiative enabling iterative evidence-based process improvements, thereby sustaining significant reductions in time-to-treat and improved clinical outcomes for AIS patients.
Highlights
Throughout the United States there is an acute ischemic stroke (AIS) occurring every 40 s and a stroke-related death occurring every 4 min, establishing stroke as the leading contender of morbidity and disability [1]
The population included patients who presented with intracranial large-vessel occlusion (LVO) or distal occlusion, posterior circulation occlusions, or carotid occlusions and were eligible for mechanical thrombectomy (MT) after undergoing a standard computed tomography (CT) protocol [Alberta Stroke Program Early CT Score (ASPECTS) ≥6], confirmation of LVO, posterior circulation, or carotid occlusions on CT angiography, and absence of intracranial hemorrhage (ICH)
We analyzed a total of 377 patients, representing clinical characteristics common in an AIS population, who underwent MT
Summary
Throughout the United States there is an acute ischemic stroke (AIS) occurring every 40 s and a stroke-related death occurring every 4 min, establishing stroke as the leading contender of morbidity and disability [1]. The quality of care in AIS has been shown to be influenced by operational modifications such as the implementation of evidence-based stroke protocols, improved staff education and training, and prioritization of hospital resources [17, 18]. The accumulation of these findings is in agreement with the necessity to improve efficiencies at individual stages of the care workflow, which is achievable through a methodologically incorporated alteration of the whole care pathway. We report the analysis of all AIS patients throughout a 6-year experience following the deployment of a quality initiative aiming at improving care, speed and maintaining quality for AIS treatment
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