ISQUA18-0031Construction of Integrated Model of Thrombolysis for Acute Ischemic Stroke

Abstract

Background: In 2015, the first base of stroke screening and prevention was set up in the Second People's Hospital of Shenzhen by the National Health Planning Commission. Patients with acute cerebral disease, especially acute ischemic stroke, were designated to our hospital for treatment. In the past, the thrombolytic treatment team was initially composed of pre-hospital first aid, emergency, and neurology department. The patients began in the hospital admissions and finally received thrombolytic therapy in the Department of Neurology. The time needed for the whole treatment process above was long to an average of 94 minutes that does not meet the 2013 US guidelines recommended, in which the doorto-needle time (DNT) should be controlled within 60 minutes. At present, DNT in China is about 150 minutes. Therefore, we set up a quality management team to study the best thrombolytic therapy model in April 2015. Objective(s): To establish the best thrombolytic treatment process, to improve the level of thrombolytic therapy, to reduce the rate of disability and mortality of patients and to improve medical quality. Methods and Results: In order to solve the above problems, the special group was set up to achieve the purpose of integrated thrombolytic therapy. 1. The establishment of the integration workflow by multidisciplinary cooperation and Easy Access In 2015, the quality improvement team was formed and the medical and nursing staff composed of the emergency department, the pre hospital emergency department, the neurology department, the radiology department, the pharmacy department and the laboratory department jointly. In the past, work flow, location, equipment and education of thrombolysis, the team analyzed the problems and formulated a series of corresponding countermeasures, and established the integration model of multi department cooperation to thrombolysis within the center of emergency Department. Through our two years of professional study, we have found several key issues that should be to improve by practice. The first problem is that the examination of the auxiliary department is time-consuming. The second problem is that the patient's waiting time is long due to the non tacit understanding of the departments. The third problem is that the treatment scheme for thrombolytic therapy is not perfect. After the revision, we first take the patient from pre hospital first aid and inform the relevant departments at the same time, so as to achieve efficient and rapid work efficiency. The results showed that the time of the neurosurgeon arriving at the emergency department examination was shortened from 40 to 13 minutes. The four reports of blood clotting were shortened from 52 to 20 minutes. The time of registration is shortened from 21 to 3 minutes. At the same time, we designed informed consent that patients and their families were more likely to accept. In this agreement, we reduced text and replaced patterns. For visual or illiterate patients or family members, the informed consent of the phonetic version is recorded. The patient's informed consent time was shortened from the 48 to 28 minutes at present. The final DNT time is shortened to 52 minutes. 2. Using rapid support system for thrombolytsis The rapid support system includes the electronic wrist band, the timer, the flat plate, the monitor and the car camera. After the patient was received on emergency vehicle, the nurse wore the wrist band. The wrist band and the timer were automatically record the patient's arrival time. The flat panel configuration was in pre-hospital, emergency department and auxiliary department, alerting the medical staff of departments to prepare for emergencies and check patient information. Monitor is configured in pre-hospital and emergency department, data was transmitted to the flat at any time, and the ambulance patients could be viewed at any time in the vehicle camera studio. 3. Establishment of the special area for thrombolytic treatment Due to the limited number of beds in the emergency department, in the past patients with acute ischemic stroke were randomly assigned to different beds after hospitalization. It also took a long time for preparations. Therefore, we divided the fixed area location for thrombolytic patients. We have also developed a perfect thrombolytic process and equipped with a fully functional thrombolytic vehicle. The treatment site of thrombolytic patients was changed to the emergency department. The thrombolytic vehicle has been retrofitted and tried repeatedly in clinical design. The products of the thrombolytic vehicle are clearly partitioned and the space of the articles placed is large and can be promoted arbitrarily. The national utility model patent for this thrombolytic vehicle has been obtained. The time of nurse for thrombolysis preparation is shortened to 18 minutes. 4. Strengthening the health education in the community and popularizing the people's understanding of the disease Because of the lack of knowledge, the patients could not go to the hospital for the first time after the onset of the disease. This leads to missing the best time for thrombolysis. By hosting the community clinic activities named "treasure brain health and prevention of brain diseases", it can make people know that early detection and timely treatment of diseases are important. Discussion(s): 1. The professional medical team will have greater ability and responsibility to improve the quality of medical care, and lead the direction of the medical development. 2. The construction of thrombolytic mode has opened the rapid reaction channel. Relevant medical staff should attach great importance to the goal of rapid thrombolysis within 60 minutes. 3. The integrated thrombolytic model has gained valuable time for the treatment of patients, and the rate of disability and mortality of the patients is reduced. 4. The thrombolytic effect was remarkable and the patient's satisfaction was improved, which makes that the three parties benefited. 5. Through the construction process and international participation, the model of integrated thrombolytic therapy for stroke is promoted.