Schregel K, Behme D, Tsogkas I, Knauth M, Maier I, Karch A,
Mikolajczyk R, Hinz J, Liman J, Psychogios MN
PLoS One. 2016;11(12):e0169192
Endovascular treatment of acute ischemic stroke has become
standard of care for patients with large artery occlusion. Early restoration of
blood flow is crucial for a good clinical outcome. We introduced an
interdisciplinary standard operating procedure (SOP) between neuroradiologists,
neurologists and anesthesiologists in order to streamline patient management.
This study analyzes the effect of optimized workflow on periprocedural timings
and its potential influence on clinical outcome. Data were extracted from a
prospectively maintained university hospital stroke database. The standard
operating procedure was established in February 2014. Of the 368 acute stroke
patients undergoing endovascular treatment between 2008 and 2015, 278 patients
were treated prior to and 90 after process optimization. Outcome measures were
periprocedural time intervals and residual functional impairment. After
implementation of the SOP, time from symptom onset to reperfusion was
significantly reduced (median 264 min prior and 211 min after SOP-introduction
(IQR 228-32 min and 161-278 min, respectively); P<0.001). Especially faster
supply of imaging and prompt transfer of patients to the angiography suite contributed
to this effect. Time between hospital admission and groin puncture was reduced
by half after process optimization (median 64 min after versus 121 min prior to
SOP-introduction (IQR 54-77 min and 96-161 min, respectively); P<0.001).
Clinical outcome was significantly better after workflow optimization as
measured with the modified Rankin Scale (common odds ratio (OR) 0.56; 95% CI
0.32-0.98; P = 0.038). Optimization of workflow and interdisciplinary teamwork
significantly improved the outcome of patients with acute ischemic stroke due
to a significant reduction of in-hospital examination, transportation, imaging
and treatment times.
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