Process Optimization And Its Performance Evaluation For Emergency Treatment In Patients With Acute Ischemic Stroke Based On Healthcare Failure Mode Effect Analysis

Objectives 1.To investigate the status quo of cerebrovascular recanalization and the the gap between with international standards time,and to provide the basis for the optimization of the process;2.To optimize the cerebral ischemia-reperfusion process for acute ischemic stroke patients by medical failure mode and effect analysis theory,so as to reduce the time of in-hospital delays.Methods This study is divided into three parts.Part Ⅰ:There were altogether 84 acute ischemic stroke patients with cerebral ischemia reperfusion were recruited by purposive sampling methods in a grade A tertiary hospital by the emergency department from January to June 2016 and were followed up throughout the whole study.To investigate the patients’ Indicators by a self-designed questionnaire :(1)Various time indicators during the whole procedure: Door to physician time(DTP)、Door to stoke team time(DTT)、Door to Imaging time(DTI)、Door to Laboratory time(DTL)、Door to needle time(DNT),Door to the Catheterization room time,Door to the mechanical embolectomy time;(2)The clinical outcome indicators: The National Institutes of Health Stroke Scale score at discharge,symptomatic cerebral hemorrhage and mortality;PartⅡ: Based on the theory of medical failure mode and effect,a multi-disciplinary management team was organized to draw and analyze the flow chart of the cerebral ischemia-reperfusion processes for acute ischemic stroke patients.By establishing the HFMEA management mode,intervention was conducted by Brainstorming and its effect was analyzed;Part Ⅲ: The optimized process management program according to the second part of the study applied to clinical practice.76 cases with acute ischemic stroke were collected from August to October 2016 in Shanghai,in a grade A tertiary hospital by the emergency department,and compared with the pre-optimization by the time index and clinical outcome index of cerebrovascular recanalization.The datas were entered by Epidada3.1 and analyzed by SPSS 22.0 software package.At last,the results of HFMEA were used to optimize the effect of emergency cerebrovascular recanalization.Results 1.This study was based on the cases study of 84 patients with acute ischemic stroke treated by emergency department from January to June 2016.The results showed that patients admitted to the CT report,admission to the inspection report,the median time from admission to thrombolytic treatment time were as follows:36 min,94 min and 88 min,and as for the time from admission to the thrombolytic treatment,only 20% succeed in less than 60 min,which are much higher than international standards;2.Based on the HFMEA theory,nine key factors were identified by the HFMEA Decision Tree analysis,they are as follows: the initial judgment;payment made by the family members and the CT reservation;and the blood sample sent by the family to the test Room;nursing care escort;decision made through doctors-patients communication whether adopting thrombolysis / thrombosis;payment by the family members for medicine;emergency room nurses dispensing;the doctor’s advice for hospitalization and contact with the catheter room;hospital formalities.And management measures were formulated for these key links.Finally,build a management model of HFMEA so as to reduce the time of in-hospital delays.3.After the conduction of the HFMEA intervention,the door to needle time(DNT)was reduced from 88(42,140)minutes to 45(37,59)minutes,(P<0.001);the ratio of patients with the DNT< 60 minutes increased from 20 % to 87.7 %(P<0.001).The door to cerebral ischemia-reperfusion time was shortened from 207(169,227)minutes to 165(155,185)minutes(P<0.05).There was no significant difference in the incidence and mortality of symptomatic cerebral hemorrhage between the two phases(before and after the intervention)(P> 0.05).Conclusion: With the prospective application of HFMEA theorems to the emergency cerebral ischemia-reperfusion process,the in-hospital delays of acute ischemic stroke patients can be effectively reduced.Conclusions 1.There is still much room for improvement of the intravenous thrombolysis process among ischemic stroke patients.We should further analyze the causes of in-hospital delay in order to establish a optimization program.2.HFMEA theory is an effective screening out the key links of in-hospital delays,and building effective management programs for the in-hospital delays of acute ischemic stroke patients.3.With the application of HFMEA theory,multidisciplinary medical resources can be converged,and the in-hospital delays can be effectively reduced,the cure rate can be improved;which is worth further popularization for it embodies the principles of patient-centered holistic treatment and personalized care.