Improving telestroke treatment times through a quality improvement initiative in a Singapore emergency department

Singapore Medical Journal
Rupeng MongCamlyn Tan

Abstract

Telestroke allows for remote determination of suitability for treatment with thrombolysis in patients with acute ischaemic stroke. However, this approach is time-dependent and most centres have yet to achieve the recommended treatment times. We describe a quality improvement initiative aimed at improving the telestroke workflow and treatment times at our centre. A multidisciplinary workgroup comprising clinicians, stroke case managers and radiology staff was formed to oversee the initiative. A phase-by-phase review of the existing workflow was done to identify the reasons for delay. Phase-specific measures were then introduced to address these delays, and a data-monitoring system was established to track the impact of these measures. The initiatives were implemented through four Plan-Do-Study-Act cycles. The door-to-needle (DTN) times for thrombolysis and clinical outcomes before and after the interventions were compared. A total of 104 patients were evaluated. The median DTN time improved from 96 minutes to 78 minutes post implementation of initiatives (p = 0.003). Fewer patients had symptomatic intracranial haemorrhages (8.5% vs. 24.2%; p = 0.03), and more patients had improvements in their National Institutes of Health Strok...Continue Reading

References

Dec 14, 1995·The New England Journal of Medicine·UNKNOWN National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group
Nov 6, 2004·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Lee H SchwammSteven R Levine
Jul 2, 2009·Telemedicine Journal and E-health : the Official Journal of the American Telemedicine Association·Rajinder SinghWei Ling Lee
Apr 23, 2011·Stroke; a Journal of Cerebral Circulation·Tatiana KharitonovaUNKNOWN Safe Implementation of Thrombolysis in Stroke Investigators
Mar 10, 2012·Telemedicine Journal and E-health : the Official Journal of the American Telemedicine Association·Bart M DemaerschalkBrett C Meyer
Mar 22, 2012·Frontiers in Neurology·Robert J AdamsTanya N Turan
May 25, 2012·Neurology·Atte MeretojaMarkku Kaste
Aug 31, 2012·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Seng H AngRajinder Singh
Jun 20, 2013·JAMA : the Journal of the American Medical Association·Jeffrey L SaverLee H Schwamm
Jul 11, 2013·Stroke; a Journal of Cerebral Circulation·Askiel BrunoJeffrey A Switzer
Nov 18, 2015·Emergency Medicine Journal : EMJ·Matthew RuddChristopher I Price
Apr 2, 2016·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Lucia NardettoBruno Giometto

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Citations

Jul 10, 2019·Telemedicine Journal and E-health : the Official Journal of the American Telemedicine Association·Benzion BlechBart M Demaerschalk
Apr 27, 2021·Frontiers in Neurology·Yumi Tomari KashidaUNKNOWN members of Northern NSW Telestroke investigators for this project

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