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Title: Door-in-Door-Out Time of 60 Minutes for Stroke With Emergent Large Vessel Occlusion at a Primary Stroke Center.
Austin Authors: Choi, Philip M C;Tsoi, Andrew H;Pope, Alun L;Leung, Shelton;Frost, Tanya;Loh, Poh-Sien;Chandra, Ronil V;Ma, Henry;Parsons, Mark;Mitchell, Peter;Dewey, Helen M
Affiliation: Department of Neurosciences, Box Hill Hospital, Eastern Health, Victoria, Australia
Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
Monash Medical Centre, and School of Clinical Sciences, Department of Medicine, Monash University, Victoria, Australia
Department of Neurology, Monash University, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
Issue Date: 2019 2019-08-29
Publication information: Stroke 2019; 50(10): 2829-2834
Abstract: Background and Purpose- Rapid reperfusion with mechanical thrombectomy in ischemic strokes with emergent large vessel occlusions leads to significant reduction in morbidity and mortality. The door-in-door-out (DIDO) time is an important metric for stroke centers without an on-site mechanical thrombectomy service. We report the outcome of a continuous quality improvement program to improve the DIDO time since 2015. Methods- Retrospective analysis of consecutive patients transferred out from a metropolitan primary stroke center for consideration of mechanical thrombectomy between January 1, 2015, and October 31, 2018. Clinical records were interrogated for eligible patients with DIDO times and reasons for treatment delays extracted. Results- One hundred thirty-three patients were transferred over the 46-month period. Median DIDO time reduced by 14% per year, from 111 minutes interquartile range (IQR, 98- 142) in 2015 to 67 minutes (IQR, 55-94) in 2018. A median DIDO time of 59 minutes (IQR, 51-80) was achieved in 2018 during working hours (0800-1700 hours). Overall, 65 patients had no documented delays (49%) with a median DIDO time of 75 minutes (IQR, 54-93) and 103 minutes (IQR, 75-143) in those with at least one delay factor documented. Conclusions- A median DIDO time of <60 minutes can be achieved in a primary stroke center.
DOI: 10.1161/STROKEAHA.119.025838
PubMed URL: 31462187
Type: Journal Article
Subjects: benchmarking
quality improvement
Appears in Collections:Journal articles

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