Needle Time Research Articles

Implementing prehospital thrombolysis in regional Tasmania

Background: Patients with ST-elevation myocardial infarction (STEMI) in regional Tasmania frequently encounter reperfusion delays. Ambulance Tasmania recently implemented prehospital thrombolysis (PHT) as part of a pharmacoinvasive strategy. This study aimed to describe a cohort of the first patient encounters involving STEMI treated under the new guideline to review the implications of the PHT initiative and inform ongoing implementation. Methods: This was a descriptive, retrospective cohort study of the first 30 consecutive patient encounters involving PHT for STEMI at Ambulance Tasmania from August 2021 to October 2022. Results: Despite meeting reperfusion targets in only two cases, the average time of 52 minutes from first medical contact (FMC) to PHT was 24.4 minutes shorter than pre-PHT. When an intensive care paramedic attended first, an additional 13 minutes was saved. There were no significant adverse events. Despite signs of successful PHT for 70% (n=21) of patients, 60% (n=18) were admitted directly to the catheterization lab for angiography and PCI. Conclusion: This study describes a cohort of patients treated under a new PHT guideline in Tasmania located too far from a percutaneous coronary intervention (PCI) centre to achieve national reperfusion targets for primary PCI, but close enough to make angiography decisions post-PHT challenging. The findings support PHT as a safe process that reduces the FMC to needle interval. Additional research is required to understand better the local PCI practices specific to Tasmania to optimize PHT as part of a broader pharmacoinvasive strategy. Recommendations for ongoing implementation include upgrading ECG transmission capability and extending thrombolysis to all levels of paramedics. The service should engage paramedics to further reduce FMC to needle times and use quality improvement initiatives to improve clinical documentation and pre-alert communication. Finally, adopting the Utstein-style data collection tool would facilitate standardized reporting and help identify areas for ongoing improvement in PHT.

Impact of Door to Needle Time of Antibiotics Administration on Outcome in Cancer Patients with Febrile Neutropenia

Impact of Door to Needle Time of Antibiotics Administration on Outcome in Cancer Patients with Febrile Neutropenia

Thrombolysis for acute ischaemic stroke with tenecteplase in a developing country: challenges and experience from a prospective observational study

ContextThis study will emphasise the importance of Tenecteplase being ideally suited as a first-choice drug for thrombolysis in AIS in developing countries, considering the numerous challenges which are faced in these parts of the world.AimTo observe the effectiveness of Tenecteplase as a thrombolytic agent in AIS and also estimate the pre-hospital and in-hospital time delays in the treatment of such patients.Material and methodsEighteen patients with non-haemorrhagic strokes who presented within the window period were included. Eight patients were thrombolysed with Tenecteplase after due consent and ruling out contraindications. Reasons for the time delay, Ictus to Needle time and NIHSS scores were noted in each case.ResultsThe mean time from onset of symptoms to arrival at the hospital was 2.06 (± 1.08) h while the mean ictus to needle time was 4.29 (± 0.20) h The delay in carrying out a CT scan in these patients was 47.5 (± 16.69) min and mean time taken in procuring Tenecteplase was 27.5 (± 18.51) min. All patients were thrombolysed within 4.5 h of the onset of stroke and seven patients had statistically significant improved NIHSS scores in the post-thrombolysis period.ConclusionsThis paper highlights the constraints in the management of AIS in a developing country, where late presentation is the norm. In-hospital delays lead to diminishing window period available for thrombolysis. This paper highlights the successful use of Tenecteplase even in the late window period and emphasises Tenecteplase as a highly effective thrombolytic agent of choice in our setting. Further studies are likely to confirm these observations in the future.

A nomogram for predicting hemorrhagic transformation in acute ischemic stroke receiving intravenous thrombolysis with extended time window.

A recent randomized controlled clinical trial expanded the time window of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) beyond 4.5 hours by applying neuroimaging standards, enabling more patients to benefit from IVT. However, hemorrhagic transformation (HT) after IVT is still a major concern. We aimed to develop a nomogram to predict HT in AIS patients receiving IVT with extended time window. We aimed to develop a nomogram to predict HT in AIS patients receiving IVT with extended time window. Patients with AIS receiving IVT with extended time window from March 2017 to April 2023 were retrospectively reviewed. They were divided into the HT group and the non-HT group based on computed tomography. Logistic regression analysis was used to screen the predictive factors for HT. A nomogram was developed based on the predictive factors. The predictive accuracy of the nomogram was assessed by the area under the curve (AUC) of the receiver operating characteristic curve (ROC). A calibration plot was used to evaluate the calibration of the nomogram. A decision curve analysis (DCA) was used to test the clinical value. A total of 210 patients were enrolled, and 44 patients (21.0%) had HT. Onset to needle time (ONT) (OR = 1.002, 95% CI: 1.000-1.004, P = .016), atrial fibrillation (OR = 2.853, 95% CI: 1.072-7.594, P = .036), and baseline NIHSS (OR = 1.273, 95% CI: 1.159-1.399, P = .000) were predictive factors of HT. The AUC of the nomogram was 0.833 (95% CI: 0.7623-0.9041), with a sensitivity of 78.9% and specificity of 77.3%. The calibration curve indicates that predicted results of the nomogram were in good agreement with the actual observation results. The DCA showed the nomogram had good clinical applicability in predicting HT. We developed an easy-to-use nomogram to predict HT in AIS patients receiving IVT with extended time window. It could be a potential tool to stratify the risk of HT for patients beyond 4.5 hours of onset who may undergo IVT.

Abstract 424: The Impact of RapidAI on Thrombectomy Notification Times in a Large, Multi‐Site, Telestroke System

Background Mechanical thrombectomy is considered the gold standard for treatment of large vessel occlusion (LVO) stroke. Early identification leads to faster puncture times as communication with the team is key. The integration of artificial intelligence (AI) platforms into acute stroke evaluation protocols may lead to more rapid and accurate detection of LVOs resulting in earlier notification of the neurointerventional (NIR) team, as was demonstrated in the VALIDATE study. In this study, we will evaluate if these findings can be generalized to other platforms such as RapidAI®. Methods Acute stroke consultations seen in the emergency department in 103 facilities (35 RapidAI® and 68 non‐AI) in 24 states from July 1, 2021 to December 31, 2021 were extracted from the TeleCare by TeleSpecialistsTM database. The encounters were reviewed for LVO, arrival‐to‐NIR notification time (ATN), and whether RapidAI® software was utilized. Patients were classified into two groups based on use of RapidAI® or no AI software. Then subcategorized further based on if they were seen at a thrombectomy capable center vs non‐thrombectomy capable center. The median arrival to NIR notification times were compared. Results A total of 14,159 patients (6,726 AI and 7,433 non‐AI) were included. The median ATN for AI was 57.5 min [40.3, 85.0] and non‐AI was 88.5 min [63.0, 116.3; Δ min = 31.0 min, p < 0.0001]. The median ATN for those at a thrombectomy center (TC) with AI was 49.0 min [36.0, 75.0] and non‐AI was 81.0 min [52.5, 97.8], p = 0.0077. The median ATN for non‐thrombectomy centers (non‐TC) with AI was 73.0 min [56.0, 115.5] and non‐AI was 90.0 min [66.5, 120.5], p = 0.0563. [TS1] . There was no difference in the AI vs non‐AI groups for door to needle times with thrombolytics at thrombectomy or non‐thrombectomy centers. Conclusions This large, multicenter study demonstrated a 31‐minute faster arrival to neurointerventionalist notification time with the aid of RapidAI®. A significant reduction in NIR notification times at both TC and non‐TC sites highlights the impact of AI software on expediting acute stroke care.

Knowledge, perceptions, and practices of blood donation among undergraduate students at Gulf Medical University, United Arab Emirates: a cross-sectional study

Ensuring safe and effective blood transfusion is essential for improving healthcare and preventing the spread of blood-borne diseases worldwide. Medical students are a potential key resource for voluntary blood donation, particularly in medical college hospitals, which can help alleviate the shortage of blood products. Additionally, they have the potential to inspire a wider segment of the population to donate blood, thereby narrowing the gap between blood supply and demand. This study aims to evaluate the knowledge, perceptions, and practices related to voluntary blood donation among undergraduate medical students at Gulf Medical University in Ajman, United Arab Emirates, and to identify the factors associated with these aspects. A cross-sectional, institution-based study was conducted among undergraduate medical students at Gulf Medical University. Data were gathered through a self-administered structured questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 27. Knowledge, perceptions, and practices related to blood donation among 301 participants were assessed. The findings revealed no significant association between knowledge levels and demographics such as gender, marital status, residence, college, or academic year. While most participants were aware of blood donation procedures and benefits, actual donation practices were low, with 84.4% rarely donating blood. Key barriers included fear of needle pain and time constraints. Health professionals and social media were the primary sources of information, indicating the need for targeted educational interventions to improve blood donation rates. Students at Gulf Medical University are well-informed about blood donation, with many willing to donate. However, fears like needle pain and time constraints limit participation. Educational efforts could help overcome these barriers.

Hospital overcrowding and care of stroke patients: Irish national audit of stroke

IntroductionHospital overcrowding where patient admissions exceed capacity is associated with worse outcomes in Emergency Department. Developments in emergency stroke care have been associated with improvements in stroke outcome but are dependent on effective, organised care. We examined if overcrowding in the hospital system was associated with negative changes in stroke outcome.MethodsData on overcrowding were obtained from the Irish Nurses and Midwives Organisation (INMO) ‘Trolley Count’ database recording the number of patients cared for on trolleys/chairs in all acute hospitals each midnight. These were compared with quarterly data from the Irish National Audit of Stroke from 2013 to 2021 inclusive. Variables analysed were inpatient mortality rate, thrombolysis rate for ischaemic stroke, median door to needle time and median length of stay.Results579449 patient episodes were recorded by Trolley Watch over the period, (Quarterly Median 16719.5, range 3389–27015). Average Quarterly Thrombolysis rate was 11.3% (sd 1.3%) Median Quarterly Inpatient Mortality rate was 11.8% (Range 8.9-14.0%). Median Quarterly Length of stay was 9 days (8–11 days). Median quarterly door to needle was 65 min (45–80 min). Q1 was typically the worst for overcrowding with on average 19777 incidences (sd 4786). This was significantly higher than for Q2 (mean 13540 (sd 4785) p = 0.005 t-test) and for Q3 (mean 14542 (sd 4753) p = 0.03). No significant correlation was found between quarterly Trolley watch episodes and inpatient mortality (r = 0.084, p = 0.63), median length of stay r=-0.15, p = 0.37) or thrombolysis rate (r = 0.089 p = 0.61). There was an unexpected significant negative correlation between trolley watch data and median door to needle time (r=-0.36, p = 0.03).ConclusionDespite increasing hospital overcrowding, stroke services still managed to preserve standard of care. We could find no association between levels of overcrowding and deterioration in selected indices of patient care.

Machine learning-based prediction of early neurological deterioration after intravenous thrombolysis for stroke: insights from a large multicenter study.

This investigation seeks to ascertain the efficacy of various machine learning models in forecasting early neurological deterioration (END) following thrombolysis in patients with acute ischemic stroke (AIS). Employing data from the Shenyang Stroke Emergency Map database, this multicenter study compiled information on 7,570 AIS patients from 29 comprehensive hospitals who received thrombolytic therapy between January 2019 and December 2021. An independent testing cohort was constituted from 2,046 patients at the First People's Hospital of Shenyang. The dataset incorporated 15 pertinent clinical and therapeutic variables. The principal outcome assessed was the occurrence of END post-thrombolysis. Model development was executed using an 80/20 split for training and internal validation, employing classifiers like logistic regression with lasso regularization (lasso regression), support vector machine (SVM), random forest (RF), gradient-boosted decision tree (GBDT), and multi-layer perceptron (MLP). The model with the highest area under the curve (AUC) was utilized to delineate feature significance. Baseline characteristics showed variability in END incidence between the training (n = 7,570; END incidence 22%) and external validation cohorts (n = 2,046; END incidence 10%; p < 0.001). Notably, all machine learning models demonstrated superior AUC values compared to the reference model, indicating their enhanced predictive capacity. The lasso regression model achieved the highest AUC at 0.829 (95% CI: 0.799-0.86; p < 0.001), closely followed by the MLP model with an AUC of 0.828 (95% CI: 0.799-0.858; p < 0.001). The SVM, RF, and GBDT models also showed commendable AUCs of 0.753, 0.797, and 0.774, respectively. Decision curve analysis revealed that the SVM and MLP models demonstrated a high net benefit. Feature importance analysis emphasized "Onset To Needle Time" and "Admission NIHSS Score" as significant predictors. Our research establishes the MLP and lasso regression as robust tools for predicting early neurological deterioration in acute ischemic stroke patients following thrombolysis. Their superior predictive accuracy, compared to traditional models, highlights the significant potential of machine learning approaches in refining prognosis and enhancing clinical decisions in stroke care management. This advancement paves the way for more tailored therapeutic strategies, ultimately aiming to improve patient outcomes in clinical practice.

Efficacy of ultrasound-guided classical versus parasacral parallel shift technique of sacral plexus block for lower limb surgeries - A randomised controlled trial.

Ultrasound-guided sacral plexus block has been used for anaesthesia and analgesia in lower limb surgeries. This study aimed to compare the block performance characteristics after ultrasound-guided (USG) sacral plexus nerve block (SNB) using the parasacral parallel shift (PSPS) approach versus the classical approach in patients undergoing orthopaedic below-knee limb surgeries. In this randomised study, 144 adult patients were randomised to receive USG SNB either by the classical approach (Group C) or the PSPS approach (Group P). A fixed dose of 20 ml of 0.5% ropivacaine was administered. Patients also received USG femoral nerve block with 10 ml of 0.5% ropivacaine. The primary outcome was the scanning time between the two groups. Secondary outcomes were the needling time, sensory and motor block onset and postoperative analgesic characteristics between the two groups. A P value of <0.05 was considered statistically significant. The needling time and the scanning time were significantly lesser in Group P than in Group C (P < 0.05). Complete sensory and motor nerve blockade of the sciatic nerve was significantly higher in Group P (P = 0.029). Block performance time, time for sensory block and time for motor block were significantly less in Group P compared to Group C (P < 0.001). The postoperative analgesic characteristics were comparable between the two groups. The sacral plexus block with ultrasound-guided parasacral parallel shift technique had a lower block performance time with lesser needling and scanning time than the classical approach.

Predicting ineffective thrombolysis in acute ischemic stroke with clinical and biochemical markers

**Ischemic stroke remains a leading cause of morbidity and mortality globally. Despite the advances in thrombolytic therapy, notably recombinant tissue plasminogen activator (rtPA), patient outcomes are highly variable. This study aims to introduce a novel predictive model, the Acute Stroke Thrombolysis Non-Responder Prediction Model (ASTN-RPM), to identify patients unlikely to benefit from rtPA within the critical early recovery window. We conducted a retrospective cohort study at Baoding No.1 Central Hospital including 709 adult patients diagnosed with acute ischemic stroke and treated with intravenous alteplase within the therapeutic time window. The ASTN-RPM was developed using Least Absolute Shrinkage and Selection Operator (LASSO) regression technique, incorporating a wide range of biomarkers and clinical parameters. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and Decision Curve Analysis (DCA). ASTN-RPM effectively identified patients at high risk of poor response to thrombolysis, with an AUC of 0.909 in the training set and 0.872 in the validation set, indicating high sensitivity and specificity. Key predictors included posterior circulation stroke, high admission NIHSS scores, extended door to needle time, and certain laboratory parameters like homocysteine levels. The ASTN-RPM stands as a potential tool for refining clinical decision-making in ischemic stroke management. By anticipating thrombolytic non-response, clinicians can personalize treatment strategies, possibly improving patient outcomes and reducing the burden of ineffective interventions. Future studies are needed for external validation and to explore the incorporation of emerging biomarkers and imaging data.

Door to needle time trends after transition to tenecteplase: A Multicenter Texas stroke registry

BackgroundTenecteplase (TNK) is considered a promising option for the treatment of acute ischemic stroke (AIS) with the potential to decrease door-to-needle times (DTN). This study investigates DTN metrics and trends after transition to tenecteplase. MethodsThe Lone Star Stroke (LSS) Research Consortium TNK registry incorporated data from three Texas hospitals that transitioned to TNK. Subject data mapped to Get-With-the-Guidelines stroke variables from October 1, 2019 to March 31, 2023 were limited to patients who received either alteplase (ALT) or TNK within the 90 min DTN times. The dataset was stratified into ALT and TNK cohorts with univariate tables for each measured variable and further analyzed using descriptive statistics. Logistic regression models were constructed for both ALT and TNK to investigate trends in DTN times. ResultsIn the overall cohort, the TNK cohort (n = 151) and ALT cohort (n = 161) exhibited comparable population demographics, differing only in a higher prevalence of White individuals in the TNK cohort. Both cohorts demonstrated similar clinical parameters, including mean NIHSS, blood glucose levels, and systolic blood pressure at admission. In the univariate analysis, no difference was observed in median DTN time within the 90 min time window compared to the ALT cohort [40 min (30–53) vs 45 min (35-55); P = .057]. In multivariable models, DTN times by thrombolytic did not significantly differ when adjusting for NIHSS, age (P = .133), or race and ethnicity (P = .092). Regression models for the overall cohort indicate no significant DTN temporal trends for TNK (P = .84) after transition; nonetheless, when stratified by hospital, a single subgroup demonstrated a significant DTN upward trend (P = 0.002). ConclusionIn the overall cohort, TNK and ALT exhibited comparable temporal trends and at least stable DTN times. This indicates that the shift to TNK did not have an adverse impact on the DTN stroke metrics. This seamless transition is likely attributed to the similarity of inclusion and exclusion criteria, as well as the administration processes for both medications. When stratified by hospital, the three subgroups demonstrated variable DTN time trends which highlight the potential for either fatigue or unpreparedness when switching to TNK. Because our study included a multi-ethnic cohort from multiple large Texas cities, the stable DTN times after transition to TNK is likely applicable to other healthcare systems.

Intravenous Thrombolysis in Acute Ischaemic Stroke Two Years into the COVID-19 Pandemic: A Retrospective Study

Abstract Introduction Changes in intravenous thrombolysis treatment rates for acute ischaemic stroke during the COVID-19 pandemic have been reported. We examined the differences in the provision of intravenous thrombolysis in patients with acute ischaemic stroke, two years prior to and two years into the COVID-19 pandemic. Methods Data were compared between March 1, 2018 to February 28, 2020 (Pre-COVID-19) and March 1, 2020 to February 28, 2022 (COVID-19). Data collected included patients’ demographics, intravenous thrombolysis rates, and patient outcomes. Results There was an increase in ischaemic stroke patient admissions during the COVID-19 period (Pre-COVID-19 n=1041, vs COVID-19 n=1087). Yet, fewer stroke patients received intravenous thrombolysis (19.2% vs 13.9%, p&lt;0.001), and there were more stroke mimics thrombolysed (8.3% vs 15.6%, p=0.021) during this period. During the COVID-19 period, there was a significant delay in hospital presentation for patients who were thrombolysed (Pre-COVID-19 = 86 minutes vs COVID-19 = 107 minutes, p = 0.004); and delay in giving thrombolysis (median door to needle time: Pre-COVID-19 = 59 minutes vs COVID-19 = 65 minutes, p = 0.002). Fewer patients had severe stroke symptoms (National Institute of Health Stroke Scale score = &gt;15) (12.2% vs 4.8%, p=0.009) during the COVID-19 period. There was no significant difference in patients’ post-thrombolysis outcome (median National Institute of Health Stroke Scale score = 1, p=0.136; discharge modified Rankin Scale score = 1, p=0.647; and mortality p=0.655). Conclusion This study showed that during the first 2 years of the COVID-19 pandemic, there was a significant decline in the thrombolysis rates and delay in the administration of the intravenous thrombolysis treatment.

Clinical profile of patients with acute ischaemic stroke undergoing thrombolysis in a tertiary hospital- A retrospective observational study

Acute ischaemic stroke is one of the most important causes of morbidity and mortality in the Indian subcontinent. Intravenous thrombolysis has revolutionized the treatment of acute stroke and has shown good evidence of its efficacy in most patients. The primary objectives of the study were to study the clinical and demographic profile of stroke patients undergoing intravenous thrombolysis and to determine their functional outcome after three months. The study was done by retrospective chart analysis of all patients with acute stroke in Neurology department undergoing intravenous thrombolysis over a one year period. Primary outcome was measured by assessing the Modified Rankin Scale after three months.A total of 56 patients underwent intravenous thrombolysis in the study period of which 68 percent were males. The average age of the study population was 62.4 years. The most common co- morbidities noted were hypertension followed by dyslipidemia, type 2 diabetes mellitus, coronary artery disease and chronic kidney disease among others. The average duration of the window period and door to needle time were 148.4 minutes and 66.3 minutes respectively. Intracranial haemorrhage was noted in seven patients (12.5%) of which six expired. Favourable outcome defined by MRS score of 0-2 was achieved in almost 68% of all patients undergoing thrombolysis.Intravenous thrombolysis is an effective mode of treatment for acute stroke with favourable outcomes obtained in the majority of patients undergoing the same.

Ultrasound guided costoclavicular block in pediatric population: A prospective observational study.

The costoclavicular space serves as an alternative approach to the infraclavicular brachial plexus block, and numerous studies in adults have demonstrated promising outcomes for distal upper limb surgery. Blocking the brachial plexus at this level is potentially advantageous because the cords are relatively superficial, located in close proximity to each other and easily identified using ultrasound. This study aimed to assess the success rate and feasibility of costoclavicular block in children undergoing unilateral below elbow upper limb surgery. Thirty children aged 2-12 years scheduled for unilateral below elbow surgery under general anesthesia were included. Costoclavicular block was performed under ultrasound and nerve stimulator guidance with 0.5% ropivacaine, 0.5 mL/kg. Success was evaluated based on the absence of significant hemodynamic response to skin incision made 20 min after the block. The sono-anatomy of costoclavicular space, ease of needling, complications, and the post-operative pain scores were assessed. The mean age and weight of the children were 6.5 ± 3.8 years and 19.7 ± 9.1 kg, respectively. The success rate of costoclavicular block in our cohort is 100%. Sonographic visualization was graded as excellent (Likert Scale 2) in 90% of cases. The plexus was located at a depth of 1.4 ± 0.3 cm from the skin, the lateral extent of cords from the artery was 0.8 ± 0.4 cm and they were observed inferior and lateral to the artery. The mean needling time was 3.6 ± 1.1 min. None of the children experienced complications such as vascular or pleural puncture, hematoma, Horner's syndrome or diaphragmatic palsy. Postoperative pain scores were low, and no rescue analgesia was required. In conclusion, the costoclavicular block exhibited a notably high success rate in pediatric population. This study substantiates that the three cords of the brachial plexus are consistently visible and superficial during ultrasound examination using this approach, confirming their separation from vascular structures and the reliable achievement of blockade without observed complications.

A quality improvement project to minimise door to needle time in acute ischaemic stroke patients at a quaternary hospital, Kochi, India

A quality improvement project to minimise door to needle time in acute ischaemic stroke patients at a quaternary hospital, Kochi, India

The Effect of Biological Sex on a County Pre-hospital Stroke Initiative

Background Females are disproportionately affected by strokes when compared to males. This may be attributed to non-traditional stroke symptoms in females and stroke care sex variance. This study explored sex and ethnicity discrepancies in the FAST-ED and stroke outcomes. Methods An internal hospital registry created in 2017 evaluated EMS FAST-ED compliance and monitored patient outcomes. We assessed two cohorts, the 2017 cohort collected one year after FAST-ED implementation, and the 2019 cohort collected two years after FAST-ED implementation. Inclusion criteria included patients aged ≥18 years arriving via EMS as a stroke alert; walk-ins were excluded. EMS FAST-ED compliance, FAST-ED score, final diagnoses, door to needle time (DTN), door to puncture (DTP) time, and stroke treatment volumes were evaluated for sex differences. Results 1,156 cases were analyzed, 638 (55%) were female. EMS FAST-ED compliance decreased by 17%, but did not differ by sex or ethnicity. EMS FAST-ED score was similar for females and males. Despite the similarity in FAST-ED score, females scored higher on the initial NIHSS ( F(1) = 6.25, p &lt; .05) and discharge NIHSS ( F(1) = 8.588, p &lt; .01). Those diagnosed with a stroke were 1.4 times more likely to be female (χ²wald = 6.21, p &lt; .01, 95% CI [1.07–1.80]). Treatment rates did not vary between sex or ethnicity and overall DTN decreased by 10 minutes (2017 cohort M = 36 minutes, SE = 1.96; 2019 cohort M = 26 minutes, SE = 1.69). Conclusions The FAST-ED demonstrated equitable implementation and scoring among a diverse population, regardless of sex or ethnicity. Additionally, patients were equally likely to receive treatment, while benefiting from a decrease in DTN times.

Construction and application of a time-saving mode in China for the treatment of acute ischemic stroke.

To explore the construction and application in the practice of green channel in No. 971 Naval Hospital of PLA (No. 971 Hospital mode) for the treatment of acute ischemic stroke (AIS). This retrospective study involved a cohort of 694 suspected stroke patients from December 2022 to November 2023 undergoing emergency treatment for stroke at our institution. Among them, 483 patients were treated with standard green channel (the control group), and 211 patients adopted the No. 971 Hospital mode for treatment (the study group). The biggest difference between the two groups was that the treatment process started before admission. We compared the effectiveness of the emergency treatment between the two groups and the thrombolysis treatment. Compared with control group, the accuracy rate of determining stroke and the rate of thrombolysis were significantly higher (p = 0.002, 0.039) and the door to doctor arrival time (DAT) and the door to CT scan time (DCT) of the study group was significantly shorter (all p < 0.001). There were 49 patients (10.1%) and 33 patients (15.6%) from the control group and study group receiving thrombolysis, respectively. The DAT, DCT, imaging to needle time (INT), and door to needle time (DNT) of patients receiving thrombolysis in the study group were significantly shorter than that in the control group (all p < 0.01). The NIHSS in the study group after the thrombolysis was lower than that in the control group (p = 0.042). No. 971 Hospital model can effectively shorten DAT, DCT, INT, and DNT, and improve the effectiveness of thrombolysis and prognoses of AIS patients.

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland.

The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P)

Aim: The Stroke Units Necessity for Patients (SUN4P) project aims to provide essential data on stroke healthcare in Greece. Herein, we present results on established quality indicators and outcomes after first-ever stroke occurrences. Methods: This prospective multicenter study included consecutive patients admitted to nine hospitals across Greece in 2019–2021. Descriptive statistics were used to present patients’ characteristics, key performance measures and stroke outcomes. Results: Among 892 patients, 755 had ischemic stroke (IS) (mean age 75.6 ± 13.6, 48.7% males) and 137 had hemorrhagic stroke (HS) (mean age 75.8 ± 13.2, 57.7% males). Of those, 15.4% of IS and 8% of HS patients were treated in the acute stroke unit (ASU) and 20.7% and 33.8% were admitted to the intensive care unit (ICU) or high-dependency unit (HDU), respectively. A total of 35 (4.6%) out of 125 eligible patients received intravenous alteplase with a door-to needle time of 60 min (21–90). The time to first scan for IS patients was 60 min (31–105) with 53.2% undergoing a CT scan within 60 min post presentation. Furthermore, 94.4% were discharged on antiplatelets, 69.8% on lipid-lowering therapy and 61.6% on antihypertensives. Oral anticoagulants (OAC) were initiated in 73.2% of the 153 IS patients with atrial fibrillation (AF). Among the 687 IS patients who survived, 85.4% were discharged home, 12% were transferred to rehabilitation centers, 1.2% to nursing homes and 1.3% to another hospital. Conclusions: The SUN4P Registry is the first study to provide data from a prospectively collected cohort of consecutive patients from nine representative national hospitals. It represents an important step in the evaluation and improvement of the quality of acute stroke care in Greece.

Abstract TP70: EHR Based System Improves Stroke Alerting Process in the Emergency Department

Background and Issues: Treatment decisions for patients experiencing acute ischemic stroke require complex imaging and evaluation. Specialized teams including Neurologists, pharmacists and CT technicians are alerted to the ED when a patient presents with signs or symptoms of acute ischemic stroke (AIS) to carry out these evaluations. At our facility, these alerts were delivered via a de-identified text message, preventing the collection of data needed for clinical effectiveness and quality improvement work. Purpose: This project's purpose was to improve the Stroke Alert process using Computerized Physician Order Entry (CPOE) to initiate the alert via a HIPAA Compliant Group Messaging (HCGM) application called Haiku. Methods: Haiku is an application available in the hospital’s electronic health record, which allows for retrieval of data unavailable when utilizing the de-identified alerting method. Data on 70 consecutive Stroke Alerts from 6 weeks prior to implementation of the Haiku Stroke Alert were compared to 80 consecutive Stroke Alerts 6 weeks after implementation. A comparison of Door to CT and Door to Needle times in those periods were also compared to ensure the new process did not cause any delays in these metrics. Results: Results showed the CPOE based Haiku Stroke Alert process was easily adopted and allowed for access to data necessary for clinical effectiveness and quality improvement work without causing delays in Door to CT (DTCT) or Door to Needle (DTN) times. Conclusions: In conclusion, this quality improvement project addressed the lack of data available to assess the Stroke Alert process. A new CPOE based alert process utilizing the HCGM app Haiku proved feasible, received positive feed-back from ED team who initiates the alert and the Neurology resident team who receives the alert. The Haiku alert did not appreciably add time to the DTCT or DTN times. This process allows access to comprehensive data that can be used to explore other avenues to improve the hyperacute phase of AIS triage and treatment. The availability of robust Stroke Alert data was the missing foundational element allowing for clinical effectiveness and quality improvement work.