Background: Acute stroke treatment has been proven to be most effective when performed quickly. The objective of our study was to describe the steps taken to improve time metrics for patients receiving intra-arterial therapy (IAT), and compare metrics before and after implementation of these standardized time saving protocols.
Hypothesis: Through streamlining the evaluation and treatment process of IAT, we predict our times between patient arrival, imaging, groin puncture and recanalization will be reduced.
Methods: On 6/1/13, we instituted a series of interventions in the Neuro-interventional Surgery department to streamline care, including: requiring the Neuro-interventional team to meet all transferred patients in the CT scanner upon patient arrival, introducing a wheeled stroke cart replete with a stroke tray containing all devices needed to perform the stroke thrombectomy, standardizing the thrombectomy procedure, switching from general anesthesia to conscious sedation for all stroke patients, and no longer shaving the groin or using a foley catheter. We also added an additional biplane INR room, doubling our room capacity. We compared time metrics of patient arrival to CT imaging, imaging to puncture, and puncture to recanalization of acute ischemic stroke patients that received IAT before (1/1/12-5/31/13) and after (6/1/13-5/31/15) the interventions using univariate analysis.
Results: Three hundred twenty-two patients received IAT during the study period. Nearly three quarters (73.3%) of the population was transferred from a referring facility. There were significantly less female patients in the post-intervention cohort (59.5% v 48.0%, p=0.04); there were no significant differences in age, race, or initial NIHSS. We found statistically significant reductions in time between patient arrival to imaging (19.2±9.6 v 13.6 ±6.7, p<0.000), imaging to puncture (57.9±36.2 v 46.9±40.5, p=0.04), and puncture to recanalization (70.7±47.3 v 53.1 ±40.4, p=.004) after implementation of the interventions.
Conclusions: Our initiatives allowed us to refine our process of care, resulting in a significant reduction of time between patient arrival and imaging, imaging and femoral artery access, and groin puncture to recanalization.