Exploring clinical outcomes of acute ischemic stroke following a door-to-needle quality improvement project
Notice bibliographique
Résumé
Background: The incidence of stroke is increasing; therefore, ongoing strategies to improve patient outcomes are needed. Timely care is an essential component of hyperacute stroke care. The earlier eligible stroke patients receive intravenous recombinant tissue plasminogen activator (rt-PA) in the narrow 4.5-hour window, the greater the likelihood of a good clinical outcome. In 2011, based on sub-optimal performance results, our centre invested in a door-to-needle (DTN) quality improvement initiative, which focused on performance feedback, stroke education, and improved workflow processes. The primary aim of this thesis study was to determine if clinical outcomes in stroke patients improved following the DTN quality improvement initiative. Methods: Guided by the Donabedian framework, we retrospectively reviewed charts of all consecutive patients (N=324) who presented to Health Sciences Centre Adult Emergency and received rt-PA pre [January 1st, 2008 to December 31st, 2010; n= 102] and post [January 1st, 2012 to December 31st, 2014; n= 224] quality improvement initiative. The washout year was 2011. Demographic and clinical patient data, and process and outcome measures were collected. Primary study outcomes included mortality, discharge location, ambulation upon discharge, and adverse events. SPSS software was used for statistical analysis, with the level of significance of .05. Results: Patients in the two groups were similar, except that in the post-intervention period more patients were rural (p <.001), arrived by ambulance (p <.001) and had longer onset-to-door times (p <.001). Median door-to-needle (DTN) time (49 vs. 70.5 min, p <.001), and the percentage of cases with a DTN ≤ 60 minute (77.9 vs. 31.4%, p <.001) improved dramatically post-intervention. Outcomes, including a reduction in in-hospital mortality, (p = .013) and an increase in the proportion of favorable (i.e., home, rehab, community hospital) versus unfavorable discharge locations (i.e., long term care, death), p=.005, were also significant. Mortality rates in all study patients with DTN ≤ 60 minutes compared to those with DTN > 60 minutes were also significantly lower (p =.004). Conclusion: This research addressed an existing gap at our hospital regarding the impact of structural and process improvements on clinical outcomes in acute stroke. Our quality improvement initiative resulted in timelier care, and likely influenced the improved clinical outcomes. This study highlights the key role of nursing as part of the multidisciplinary team, in lessening the impact of stroke. The findings also provide institutional and governmental organizations with evidence to support investing in hyperacute stroke care. Furthermore, this study will foster increased uptake and compliance with best practice stroke care. Ultimately, all stroke patients in Manitoba may benefit, as it may increase the adherence to time-driven hyperacute stroke protocols. Thus, this study has provided valuable insights and reasons for optimism in the future of stroke care at HSC, in the Province of Manitoba, and beyond.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».