Standardized protocol may shorten time to stroke intervention

Standardizing stroke protocols to have patients with suspected emergent large-vessel occlusion be met by a neurointerventional team upon arrival to the hospital appears to improve time to recanalization, according to a presentation at the Society of Neurointerventional Surgery Annual Meeting.

According to the analysis, having a five-person team consisting of one registered nurse, two technologists, one anesthesiologist and one neurointerventionalist meet the patient upon arrival to the ED was the most important reason for saving door-to-recanalization time.

“Level 1 trauma centers require trauma surgeons and anesthesiologists to be in-house 24/7. By requiring level 1 stroke centers to do the same, we could potentially help more [emergent large-vessel occlusion] patients make full recoveries,” presenter Donald Frei, MD, a neurointerventional surgeon at Radiology Imaging Associates, Denver, said in a press release.

Frei and colleagues analyzed 1,162 patients who prompted activation of the neurointerventional team at Radiology Imaging Associates between 2017 and March 2018, of whom 27% underwent thrombectomy.

The thrombectomy rate was 21% during weekday working hours, 43% on weekdays after 5 p.m. and 29% on weekends, according to the researchers.

The nurse and technologists received 2 hours of overtime pay for each alert that did not lead to thrombectomy, totaling more than $200,000 per year.

However, median time from patient arrival to recanalization was 52 minutes, lower than the recommended threshold of 90 minutes, whereas median time from arrival to groin puncture was 34.5 minutes and median time from groin puncture to recanalization was 17.5 minutes, according to the researchers.

“This study shows that stroke systems of care can and should be streamlined to ensure the best possible outcomes for patients,” Frei said in the release. “The associated costs also suggest that in-house neurointerventional teams at hospitals may be the most effective option for rapid and safe care. The additional annual cost in overtime pay for the team is far outweighed by the huge benefit in decreasing the costs of lifelong disability because many more patients can return to independence.” – by Erik Swain

Reference:

Frei D, et al. Door to revascularization in less than 60 minutes: A cost and benefit analysis. Presented at: Society of Neurointerventional Surgery Annual Meeting; July 23-26, 2018; San Francisco.

Disclosure: Frei reports he has financial ties with Cerenovus, Genentech, Microvention, Medtronic, Penumbra, Siemens and Stryker.