Improving treatment times for patients with in-hospital stroke using a standardized protocol

Junpei Koge, Shoji Matsumoto, Ichiro Nakahara, Akira Ishii, Taketo Hatano, Nobutake Sadamasa, Yasutoshi Kai, Mitsushige Ando, Makoto Saka, Hideo Chihara, Wataru Takita, Keisuke Tokunaga, Takahiko Kamata, Hidehisa Nishi, Tetsuya Hashimoto, Atsushi Tsujimoto, Jun ichi Kira, Izumi Nagata

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Methods Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008–March 2014) and after implementation (April 2014–December 2016). Results Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5 min, p < 0.01) and to first neuroimaging (50 vs. 26.5 min, p < 0.01) and in the median time from first neuroimaging to intravenous thrombolysis (45 vs. 16 min, p = 0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53 min, p = 0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0–2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Conclusion Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety.

Original languageEnglish
Pages (from-to)68-73
Number of pages6
JournalJournal of the Neurological Sciences
Volume381
DOIs
Publication statusPublished - Oct 15 2017

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Stroke
Neuroimaging
Therapeutics
Intracranial Hemorrhages
Clinical Protocols
Safety
Education
Incidence

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Koge, J., Matsumoto, S., Nakahara, I., Ishii, A., Hatano, T., Sadamasa, N., ... Nagata, I. (2017). Improving treatment times for patients with in-hospital stroke using a standardized protocol. Journal of the Neurological Sciences, 381, 68-73. https://doi.org/10.1016/j.jns.2017.08.023

Improving treatment times for patients with in-hospital stroke using a standardized protocol. / Koge, Junpei; Matsumoto, Shoji; Nakahara, Ichiro; Ishii, Akira; Hatano, Taketo; Sadamasa, Nobutake; Kai, Yasutoshi; Ando, Mitsushige; Saka, Makoto; Chihara, Hideo; Takita, Wataru; Tokunaga, Keisuke; Kamata, Takahiko; Nishi, Hidehisa; Hashimoto, Tetsuya; Tsujimoto, Atsushi; Kira, Jun ichi; Nagata, Izumi.

In: Journal of the Neurological Sciences, Vol. 381, 15.10.2017, p. 68-73.

Research output: Contribution to journalArticle

Koge, J, Matsumoto, S, Nakahara, I, Ishii, A, Hatano, T, Sadamasa, N, Kai, Y, Ando, M, Saka, M, Chihara, H, Takita, W, Tokunaga, K, Kamata, T, Nishi, H, Hashimoto, T, Tsujimoto, A, Kira, JI & Nagata, I 2017, 'Improving treatment times for patients with in-hospital stroke using a standardized protocol', Journal of the Neurological Sciences, vol. 381, pp. 68-73. https://doi.org/10.1016/j.jns.2017.08.023
Koge, Junpei ; Matsumoto, Shoji ; Nakahara, Ichiro ; Ishii, Akira ; Hatano, Taketo ; Sadamasa, Nobutake ; Kai, Yasutoshi ; Ando, Mitsushige ; Saka, Makoto ; Chihara, Hideo ; Takita, Wataru ; Tokunaga, Keisuke ; Kamata, Takahiko ; Nishi, Hidehisa ; Hashimoto, Tetsuya ; Tsujimoto, Atsushi ; Kira, Jun ichi ; Nagata, Izumi. / Improving treatment times for patients with in-hospital stroke using a standardized protocol. In: Journal of the Neurological Sciences. 2017 ; Vol. 381. pp. 68-73.
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abstract = "Background Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Methods Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008–March 2014) and after implementation (April 2014–December 2016). Results Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5 min, p < 0.01) and to first neuroimaging (50 vs. 26.5 min, p < 0.01) and in the median time from first neuroimaging to intravenous thrombolysis (45 vs. 16 min, p = 0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53 min, p = 0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0–2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Conclusion Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety.",
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AU - Koge, Junpei

AU - Matsumoto, Shoji

AU - Nakahara, Ichiro

AU - Ishii, Akira

AU - Hatano, Taketo

AU - Sadamasa, Nobutake

AU - Kai, Yasutoshi

AU - Ando, Mitsushige

AU - Saka, Makoto

AU - Chihara, Hideo

AU - Takita, Wataru

AU - Tokunaga, Keisuke

AU - Kamata, Takahiko

AU - Nishi, Hidehisa

AU - Hashimoto, Tetsuya

AU - Tsujimoto, Atsushi

AU - Kira, Jun ichi

AU - Nagata, Izumi

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N2 - Background Previous reports have shown significant delays in treatment of in-hospital stroke (IHS). We developed and implemented our IHS alert protocol in April 2014. We aimed to determine the influence of implementation of our IHS alert protocol. Methods Our implementation processes comprise the following four main steps: IHS protocol development, workshops for hospital staff to learn about the protocol, preparation of standardized IHS treatment kits, and obtaining feedback in a monthly hospital staff conference. We retrospectively compared protocol metrics and clinical outcomes of patients with IHS treated with intravenous thrombolysis and/or endovascular therapy between before (January 2008–March 2014) and after implementation (April 2014–December 2016). Results Fifty-five patients were included (pre, 25; post, 30). After the implementation, significant reductions occurred in the median time from stroke recognition to evaluation by a neurologist (30 vs. 13.5 min, p < 0.01) and to first neuroimaging (50 vs. 26.5 min, p < 0.01) and in the median time from first neuroimaging to intravenous thrombolysis (45 vs. 16 min, p = 0.02). The median time from first neuroimaging to endovascular therapy had a tendency to decrease (75 vs. 53 min, p = 0.08). There were no differences in the favorable outcomes (modified Rankin scale score of 0–2) at discharge or the incidence of symptomatic intracranial hemorrhage between the two periods. Conclusion Our IHS alert protocol implementation saved time in treating patients with IHS without compromising safety.

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