1
|
Tahtali D, Bohmann F, Kurka N, Rostek P, Todorova-Rudolph A, Buchkremer M, Abruscato M, Hartmetz AK, Kuhlmann A, Henke C, Stegemann A, Menon S, Misselwitz B, Reihs A, Weidauer S, Thonke S, Meyding-Lamadé U, Singer O, Steinmetz H, Pfeilschifter W. Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial. PLoS One 2017; 12:e0188231. [PMID: 29206838 PMCID: PMC5716597 DOI: 10.1371/journal.pone.0188231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background To meet the requirements imposed by the time-dependency of acute stroke therapies, it is necessary 1) to initiate structural and cultural changes in the breadth of stroke-ready hospitals and 2) to find new ways to train the personnel treating patients with acute stroke. We aimed to implement and validate a composite intervention of a stroke team algorithm and simulation-based stroke team training as an effective quality initiative in our regional interdisciplinary neurovascular network consisting of 7 stroke units. Methods We recorded door-to-needle times of all consecutive stroke patients receiving thrombolysis at seven stroke units for 3 months before and after a 2 month intervention which included setting up a team-based stroke workflow at each stroke unit, a train-the-trainer seminar for stroke team simulation training and a stroke team simulation training session at each hospital as well as a recommendation to take up regular stroke team trainings. Results The intervention reduced the network-wide median door-to-needle time by 12 minutes from 43,0 (IQR 29,8–60,0, n = 122) to 31,0 (IQR 24,0–42,0, n = 112) minutes (p < 0.001) and substantially increased the share of patients receiving thrombolysis within 30 minutes of hospital arrival from 41.5% to 59.6% (p < 0.001). Stroke team training participants stated a significant increase in knowledge on the topic of acute stroke care and in the perception of patient safety. The overall course concept was regarded as highly useful by most participants from different professional backgrounds. Conclusions The composite intervention of a binding team-based algorithm and stroke team simulation training showed to be well-transferable in our regional stroke network. We provide suggestions and materials for similar campaigns in other stroke networks.
Collapse
Affiliation(s)
- Damla Tahtali
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ferdinand Bohmann
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Natalia Kurka
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Rostek
- NICU Nursing Staff, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | | | | | | | - Andrea Kuhlmann
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Christian Henke
- Department of Neurology, Helios HSK Wiesbaden, Wiesbaden, Germany
| | - André Stegemann
- Department of Neurology, Sankt Katharinen-Krankenhaus, Frankfurt am Main, Germany
| | - Sanjay Menon
- Department of Neurology, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Björn Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Germany
| | - Anke Reihs
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Germany
| | - Stefan Weidauer
- Department of Neurology, Sankt Katharinen-Krankenhaus, Frankfurt am Main, Germany
| | - Sven Thonke
- Department of Neurology, Klinikum Hanau, Hanau, Germany
| | - Uta Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Oliver Singer
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
- * E-mail:
| |
Collapse
|
2
|
Pfeilschifter W, Farahmand D, Niemann D, Ikenberg B, Hohmann C, Abruscato M, Thonke S, Strzelczyk A, Hedtmann G, Neumann-Haefelin T, Kollmar R, Singer OC, Ferbert A, Steiner T, Steinmetz H, Reihs A, Misselwitz B, Foerch C. Estimating the Quantitative Demand of NOAC Antidote Doses on Stroke Units. Cerebrovasc Dis 2016; 42:415-420. [PMID: 27438461 DOI: 10.1159/000447952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit. METHODS We extracted data of patients with acute ischemic stroke and ICH (<24 h after symptom onset) in the years 2012-2015 from a state-wide prospective stroke inpatient registry. We selected 8 stroke units and determined the mode of OAT upon admission in 2012-2013. In 2015, the mode of OAT became a mandatory item of the inpatient registry. From the number of anticoagulated patients and the NOAC share, we estimated the current and future demand for NOAC antidote doses on stroke units. RESULTS Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate. CONCLUSIONS Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.
Collapse
|
3
|
Pfeilschifter W, Abruscato M, Hövelmann S, Baas H. Thrombolysis in a stroke patient on dabigatran anticoagulation: case report and synopsis of published cases. Case Rep Neurol 2013; 5:56-61. [PMID: 23626566 PMCID: PMC3635684 DOI: 10.1159/000350570] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We present the case of an aphasic 77-year-old stroke patient with left distal M1 occlusion who received rt-PA for thrombolysis while on oral anticoagulant treatment with dabigatran (150 mg b.i.d.). Coagulation parameters were normal (thrombin time 20 s, aPTT 20 s, INR 1.08) and the patient improved from an NIHSS of 15 to 5 within 24 h with sonographic evidence of M1 recanalization. She did not develop intracranial bleeding complications but showed unusually large diffuse skin ecchymoses. In our report, we give an overview of all reported cases of thrombolysis under dabigatran anticoagulation and discuss the questions of medication adherence under novel oral anticoagulants (NOA) and the safety of NOA in terms of secondary intracerebral hemorrhage after stroke.
Collapse
|