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. 2022 Jul 26;22(1):136.
doi: 10.1186/s12873-022-00692-8.

Shortening door-to-puncture time and improving patient outcome with workflow optimization in patients with acute ischemic stroke associated with large vessel occlusion

Shuiquan Yang #  1 , Weiping Yao #  2 , James E Siegler  3 , Mohammad Mofatteh  4 , Jack Wellington  5 , Jiale Wu  6   7 , Wenjun Liang  1 , Gan Chen  1 , Zhou Huang  8 , Rongshen Yang  6   7 , Juanmei Chen  9 , Yajie Yang  10 , Zhaohui Hu  11 , Yimin Chen  12
Affiliations

Shortening door-to-puncture time and improving patient outcome with workflow optimization in patients with acute ischemic stroke associated with large vessel occlusion

Shuiquan Yang et al. BMC Emerg Med. .

Abstract

Objective: We aimed to evaluate door-to-puncture time (DPT) and door-to-recanalization time (DRT) without directing healthcare by neuro-interventionalist support in the emergency department (ED) by workflow optimization and improving patients' outcomes.

Methods: Records of 98 consecutive ischemic stroke patients who had undergone endovascular therapy (EVT) between 2018 to 2021 were retrospectively reviewed in a single-center study. Patients were divided into three groups: pre-intervention (2018-2019), interim-intervention (2020), and post-intervention (January 1st 2021 to August 16th, 2021). We compared door-to-puncture time, door-to-recanalization time (DRT), puncture-to-recanalization time (PRT), last known normal time to-puncture time (LKNPT), and patient outcomes (measured by 3 months modified Rankin Scale) between three groups using descriptive statistics.

Results: Our findings indicate that process optimization measures could shorten DPT, DRT, PRT, and LKNPT. Median LKNPT was shortened by 70 min from 325 to 255 min(P < 0.05), and DPT was shortened by 119 min from 237 to 118 min. DRT shortened by 132 min from 338 to 206 min, and PRT shortened by 33 min from 92 to 59 min from the pre-intervention to post-intervention groups (all P < 0.05). Only 21.4% of patients had a favorable outcome in the pre-intervention group as compared to 55.6% in the interventional group (P= 0.026).

Conclusion: This study demonstrated that multidisciplinary cooperation was associated with shortened DPT, DRT, PRT, and LKNPT despite challenges posed to the healthcare system such as the COVID-19 pandemic. These practice paradigms may be transported to other stroke centers and healthcare providers to improve endovascular time metrics and patient outcomes.

Keywords: Door-to-puncture time; Door-to-recanalization time; Endovascular therapy; Ischemic stroke; Puncture-to-recanalization time; Workflow optimization.

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Conflict of interest statement

James E. Siegler reports consulting fees for Ceribell and speakers bureau for AstraZeneca, both unrelated to the present work. Other authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Median LKNPT, DPT, DRT, and PRT (min) from 2018 to 2021. All measurements showed a decreasing trend across the study period
Fig. 2
Fig. 2
The target goal of DPT ≤ 120 min showed consistent improvements over the study period
See this image and copyright information in PMC

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