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Diagnostic investigations in adults with suspected stroke-improvement of door-to-imaging time: a best practice implementation project

. 2025 Jan 01 ; 23 (S1) : S27-S34. [epub] 20250101

Language English Country United States Media electronic

Document type Journal Article

Links

PubMed 39989352
DOI 10.1097/xeb.0000000000000497
PII: 02205615-990000000-00160
Knihovny.cz E-resources

OBJECTIVES: This evidence implementation project aimed to assess and improve compliance with evidence-based neuroimaging criteria for adult patients with suspected stroke. INTRODUCTION: Stroke is the second leading cause of mortality and severe disability, requiring timely and accurate diagnosis. Clinical guidelines recommend brain imaging within 60 minutes of hospital arrival for suspected stroke patients. This project involved hospitals in North West Anglia NHS Foundation Trust, UK, serving 850,000 people with over 800 admissions annually. METHODS: The JBI Evidence Implementation Framework was used to guide this project. JBI software, the Practical Application of Clinical Evidence System (PACES), as well as JBI's Getting Research into Practice (GRiP) approach, were used to conduct the audit and implementation phases. The project followed three stages: (1) implementation planning, (2) baseline assessment and implementation, and (3) impact evaluation. Three audit criteria were used to represent best practices for diagnosing suspected stroke patients. RESULTS: The baseline audit revealed low compliance with the first criterion, with only 2.9% (1/35) of patients receiving a CT head scan within 1 hour of admission. In the follow-up audit, compliance improved to 45.2% (14/31). The other two criteria, diagnosis by a trained health care professional and baseline ECG assessment, had already achieved 100% compliance in the baseline audit. CONCLUSIONS: Compliance with evidence-based neuroimaging criteria improved after implementing targeted educational strategies and training. The rate of CT scans conducted within 1 hour increased, although door-to-imaging times remain suboptimal compared with achievable benchmarks of ≤ 20 minutes. Ongoing education and training are crucial for sustaining high compliance and improving stroke patient outcomes. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A324.

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Stroke Foundation. Living clinical guidelines for stroke management [internet]. Stroke Foundation; 2019 [cited 2022 Jun 30]. Available from: https://informme.org.au/Guidelines/Clinical-Guidelines-for-Stroke-Management

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50 (12):e344–e418.

Intercollegiate Stroke Working Party. National guideline for stroke, 5th ed [internet]. Royal College of Physicians; 2016 [cited 2022 Jun30]. Available from: https://www.bgs.org.uk/sites/default/files/content/resources/files/2018-06-05/national_guidelines_2016.pdf

National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management [internet]. NICE; 2019 [cited 2022 Jun 30]. Available from: https://www.nice.org.uk/guidance/ng128

Boulanger JM, Lindsay MP, Gubitz G, Smith EE, Stotts G, Foley N, et al. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke 2018; 13 (9):949–984.

Stroke Association. Stroke statistics [internet]. Stroke Association [cited 2022 Jun 30]. Available from: http://www.stroke.org.uk/what-is-stroke/stroke-statistics

Sentinel Stroke National Audit Programme. SSNAP [cited 2022 Jun 30]. Available from: http://www.strokeaudit.org

Getting it Right First Time. GIRFT [cited 2022 Jun 30]. Available from: http://www.gettingitrightfirsttime.co.uk

Porritt K, McArthur A, Lockwood C, Munn Z. JBI's approach to evidence implementation: a 7-phase process model to support and guide getting evidence into practice. JBI Evid Implement 2023; 21:3–13.

Saver JL. Time is brain—quantified. Stroke 2006; 37:263–266.

Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995; 333:1581–1587.

Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363 (9411):768–774.

Mikulík R, Bar M, Bělašková S, Černík D, Fiksa J, Herzig R, et al. Ultrashort door-to-needle time for intravenous thrombolysis is safer and improves outcome in the Czech Republic: nationwide study 2004 to 2019. J Am Heart Assoc 2022; 11 (10):e023524.

Messé SR, Khatri P, Reeves MJ, Smith EE, Saver JL, Bhatt DL, et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology 2016; 87 (15):1565–1574.

Aghaebrahim A, Streib C, Rangaraju S, Kenmuir CL, Giurgiutiu DV, Horev A, et al. Streamlining door to recanalization processes in endovascular stroke therapy. J Neurointerv Surg 2017; 9 (4):340–345.

Kelly AG, Hellkamp AS, Olson D, Smith EE, Schwamm LH. Predictors of rapid brain imaging in acute stroke: analysis of the Get With the Guidelines-Stroke program. Stroke 2012; 43 (5):1279–1284.

Mikulik R, Bar M, Cernik D, Herzig R, Jura R, Jurak L, et al. Stroke 20 20: implementation goals for intravenous thrombolysis. Eur Stroke J 2021; 6 (2):151–159.

Shen G, Xia Q, Zhang X, Xue P, Wang Y, Wang J. Dysphagia screening among stroke patients in a tertiary hospital: a best practice implementation project. JBI Evid Implement 2024; 22 (2):158–166.

Wang R, Wei W, Zhou J, Yu M, Zhang X, Luo Y, et al. Clinical assessment and screening of stroke patients with aphasia: a best practice implementation project. JBI Evid Implement 2022; 20 (2):144–153.

Sauser K, Levine DA, Nickles AV, Reeves MJ. Hospital variation in thrombolysis times among patients with acute ischemic stroke: the contributions of door-to-imaging time and imaging-to-needle time. JAMA Neurol 2014; 71:1155–1161.

Haršány M, Kadlecová P, Švigelj V, Kõrv J, Kes VB, Vilionskis A, et al. Factors influencing door-to-imaging time: analysis of the safe implementation of treatments in Stroke-EAST registry. J Stroke Cerebrovasc Dis 2014; 23 (8):2122–2129.

Reznek MA, Murray E, Youngren MN, Durham NT, Michael SS. Door-to-imaging time for acute stroke patients is adversely affected by emergency department crowding. Stroke 2017; 48:49–54.

Nolte CH, Malzahn U, Kühnle Y, Ploner CJ, Müller-Nordhorn J, Möckel M. Improvement of door-to-imaging time in acute stroke patients by implementation of an all-points alarm. J Stroke Cerebrovasc Dis 2013; 22 (2):149–153.

Bonadio W, Beck C, Mueller A. Impact of CT scanner location on door to imaging time for emergency department stroke evaluation. Am J Emerg Med 2020; 38:309–310.

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