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29-11-2011 | Article

Protocol reduces time to brain imaging for inpatient stroke


Free abstract

MedWire News: Use of an inpatient stroke protocol may speed up receipt of brain imaging in patients who suffer a stroke while in hospital, US researchers report.

This, they add, "demonstrates that quality of in-hospital stroke care can be improved."

The researchers also highlight that speeding up time to imaging in stroke patients permits faster administration of thrombolytic therapy and may therefore lead to improved clinical outcomes.

The team, led by Ethan Cumbler (University of Colorado, Denver), assessed the effects of implementing a four-step protocol in the care of patients who have a stroke while in hospital.

The protocol, which was implemented at the University of Colorado Hospital, involved the mapping of areas of inefficiency in the hospital's inpatient stroke identification and treatment pathway, development of an optimized care pathway, implementation of a checklist of main practices for members of the acute stroke response team, and feedback on the impact of these steps on overall stroke patient care.

Writing in the Journal of Hospital Medicine, Cumbler and team report that they assessed time from stroke alert to commencement of computed tomography (CT) brain scanning (alert-to-CT time) over the 6-month period before use of the protocol was initiated. This was compared with alert-to-CT time during the 3-month period after the protocol was implemented.

Over the entire study period, 75 inpatient strokes occurred, of which 31 occurred in the pre-intervention period and 44 occurred in the postintervention period.

The researchers found that the median alert-to-CT time was more than twice as long before the intervention than after, with median durations of 69.0 and 29.5 minutes, respectively.

Current guidelines from the American Stroke Association (ASA) recommend that brain imaging should be started within 25 minutes of stroke onset. Only 19% of the hospital's stroke patients met this goal pre-intervention, but this proportion increased to 32% after initiation of the intervention.

These findings "suggest that dramatic improvements are possible through systematic evaluation and redesign of hospital response processes, a checklist for in-hospital stroke carried by front-line responders, and on-going real-time feedback," say Cumbler et al.

They conclude that in-hospital stroke quality initiatives should be employed by all hospitals that care for stroke patients to ensure that no patient is ever denied thrombolytic therapy because of ineffective management strategies.

By Lauretta Ihonor