AUTHOR=Yuan Guangxiong , Xia Hong , Xu Jun , Long Chen , Liu Lei , Huang Feng , Zeng Jianping , Yuan Lingqing 

TITLE=Reducing intravenous thrombolysis delay in acute ischemic stroke through a quality improvement program in the emergency department

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.931193

DOI=10.3389/fneur.2022.931193

ISSN=1664-2295

ABSTRACT=Abstract: Objective: This study aims to investigate the effectiveness of a quality improvement program for reducing intravenous thrombolysis (IVT) delay in acute ischemic stroke (AIS). Materials and Methods: We implement a quality improvement program consisting of 10 interventions for reducing IVT delay, including: establishment of acute stroke team, standardized management of stroke teams, popularizing stroke and its treatment, emergency bypass route (BER), the achievement of computed tomography (CT) priority, no-delay CT interpretation, intravenous thrombolysis on the CT table, payment after treatment, whole recording, and incentive policy. We retrospectively analysed the clinical time and outcome data of AIS patients treated with IVT in pre-intervention (108 patients) and post-intervention groups (598 patients), and further compared the differences between the non-emergency bypass route (NBER) and BER in the post-intervention group. Results: The thrombolysis rate increased from approximately 29% in the pre-intervention group to 48% in the post-intervention group. Compared with pre-intervention group, the median of DNT (door-to-needle time) was greatly shortened from 95 minutes to 26 minutes (P < 0.001), and DCT (door-to-CT time) was noticeably decreased from 20 minutes to 18 minutes (P < 0.001), and OTT (onset-to-needle time) significantly declined from 206 minutes to 133 minutes (P = 0.001). Under the new mode after intervention, we further analysed the IVT delay difference between the NBER (518 patients) and BER group (80 patients) from the post-intervention group. The median of DNT (18 vs 27 minutes, P < 0.001), DCT (10 vs 19 minutes, P < 0.001) and OTT (99 vs 143 minutes, P < 0.001) showed significant reductions in the BER group. The quality improvement program under the emergency platform successfully controlled the median of DNT to within 26 minutes. Conclusions: Collectively, the BER mode is a feasible scheme that greatly decreased DNT for AIS patients, and the secret to success was to accomplish as much as possible before the patient arrives at the emergency room.