摘要
Objective:Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes.This study investigated whether optimizing intravenous thrombolytic(IVT)therapy strategies for stroke could reduce treatment delays.Methods:To reduce delays in IVT therapy for ischemic stroke,a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou,Zhejiang Province,from June 2021 to August 2023,which included developing a timeline process management system,forming a nurse-led stroke process management team,providing homogeneous training,standardizing the IVT therapy process for ischemic stroke,and introducing an incentive policy.During the pre-(from June 2021 to February 2022,group A)and post-(from March to November 2022,group B1;from December 2022 to August 2023,group B2[implementation of an additional incentive policy])of the implementation the strategy,the door-tocomputed tomographic angiography(CTA)time(DCT),CTA time,neurology consultation to consent for IVT,CTA-to-needle time(CNT),and door-to-needle time(DNT),the percentage of people who underwent CTA within 20 min,15 min,and 10 min and DNT within 60 min,45 min,and 30 min were collected and compared.Results:Following the implementation of the standardized IVT process management strategy for stroke,the DNT for group B1 and group B2 were 30(24,44)min and 31(24,41)min,respectively,both significantly lower than the 46(38,58)min in group A(P<0.001);the median DCT were both 13 min in group B1 and B2 lower than 17min in group A(P<0.001);the median CTA were 12 min in Group B1 and 9 min in Group B2 lower than 14 min in group A(P<0.001);similar results were observed during the neurology consultation to obtain consent for IVT and CNT.Compared with group A,the proportion of DCT20 min,15 min,and 10 min was higher in groups B1 and B2(P<0.05),and the same result was observed at DNT60 min,45 min,and 30 min(P<0.05).However,the additional incentive policy did not significantly differ between Group B2 and Group B1.Conclusions:Optimizing IVT therapy for ischemic stroke is a feasible approach to limit the DNT to 30 min in ischemic stroke,significantly reducing delays within the therapeutic window and increasing the number of patients meeting target time segments.Additionally,generating a timeline for the IVT therapy process by scanning positioning quick response codes was a significant breakthrough in achieving the informatization of IVT quality management for stroke.
目的在治疗时间窗内对缺血性脑卒中患者进行早期溶栓治疗与改善临床结局相关。该研究旨在建立了基于时间轴流程管理的卒中护士主导的缺血性脑卒中患者静脉溶栓流程,并评价其应用效果。方法为了减少缺血性脑卒中患者从入院到开始静脉溶栓时间(door-to-needle time,DNT),2021年6月至2023年8月,在中国浙江省杭州市1所三级甲等医院实施了以卒中护士为主导的缺血性脑卒中患者静脉溶栓流程,包括创建时间轴流程管理系统、组建卒中护士主导的流程管理团队、开展团队成员同质化培训、制订标准化卒中静脉溶栓治疗流程及激励政策等内容。在治疗策略实施前(2021年6月至2022年2月,A组)及实施后[2022年3月至11月,B1组;2022年12月至2023年8月,B2组(增加奖励政策)],分别调查入院到CT血管造影(computed tomographic angiography,CTA)时间(Door-to-CTA time,DCT)、CTA时间、神经科会诊到同意静脉溶栓治疗时间、CTA到开始静脉溶栓时间(CTA-to-needle time,CNT)和入院到开始静脉溶栓时间(door-to-needle time,DNT)及时间节点内的达标人数(DCT分别小于20 min、15 min及10 min;DNT分别小于60 min、45 min及30 min)。结果策略实施后,B1组和B2组的DNT分别为30(24,44)min和31(24,41)min,均低于A组的46(38,58)min(P<0.001);DCT分别为13(10,17)min和13(10,16.5)min,低于A组的17(13,21)min(P<0.001);B1组和B2组的CTA分别为12(10,15)min和9(6,12)min,低于A组的中位数14(11,17)min(P<0.001);在神经科会诊到同意静脉溶栓治疗的时间和CNT这两个指标中均观察到了相似的结果。B1和B2组DCT分别小于20 min、15 min和10 min;DNT分别小于60 min、45 min和30 min的达标比例均高于A组(P<0.05)。虽然,额外增加了奖励政策,但B1组和B2组之间差异无统计学意义(P>0.05)。结论实施卒中护士主导的静脉溶栓流程能有效减少卒中静脉溶栓时间,增加DNT30 min以内的达标人数,减少治疗时间窗内的延误。此外,通过扫描定位二维码生成静脉溶栓治疗流程的时间轴,是实现卒中静脉溶栓治疗质量管理信息化的重要突破。
基金
supported by Zhejiang Provincial Medical and Health Science and Technology Plan Project(2023KY448).
