| ObjectiveCombined with the current situation of in-hospital rescue of acute ischemic stroke and the development needs of the hospital,a one-stop station rescue process of acute ischemic stroke was constructed,in which the catheter room nurses were the main force of in-hospital emergency care,and the process practice and effect evaluation were completed.In order to provide new ideas for the hospital rescue work of AIS and improve the quality of hospital rescue of acute ischemic stroke.Methods1.According to the statistics of hospital rescue process of AIS patients prepared by the research group,the rescue process of acute ischemic stroke was recorded on site,and the efficiency of rescue process was analyzed based on the case review results,and compared with the time of international rescue node.The problems in the rescue process were analyzed by single factor analysis and multivariate logistic regression analysis,and the reasons for restricting the efficiency of rescue were found.2.The hospital rescue mode of AIS at home and abroad was analyzed through literature research.3.According to the case review,field observation and literature research results,the interview outline is formulated,the stroke team members are interviewed qualitatively,and the problems in the routine rescue process are found in depth,which provides the basis for the construction of the new process.4.According to the results of the previous research,under the guidance of process management theory,combined with the rescue equipment and personnel structure of our hospital,the one-stop station rescue process is constructed,and the feasibility of one-stop rescue process is determined by expert group meeting.5.The effect of one-stop station rescue process in hospital of acute ischemic stroke was evaluated by using experimental study,including rescue efficiency,outcome,economic index and satisfaction of stroke team to nurses in catheter room.Results1.Case review and field observation included 127 acute ischemic stroke patients who received reperfusion treatment in emergency department from January to December 2019.The median time of Door-to-Needle Time was 51.5(47.0,60.0)minutes,which was lower than the international standard of 60 minutes;The median time of Door-to-Puncture Time was 107.0(80.00,138.0)minutes,which was higher than the international standard of 90 minutes.Multivariate logistic regression analysis showed that patients with intravenous thrombolysis from emergency admission to stroke doctor(OR = 5.32,95% CI: 1.49 ～19.06),from arrival at CT room to start CT scan(OR = 5.92,95% CI: 1.39 ～ 25.30),from completion of CT scan to signing of intravenous thrombolysis agreement(OR =12.14,95% CI: 3.03 ～ 48.67),from signing of thrombolysis agreement to start thrombolysis(OR = 7.60,95% CI: 2.07 ～ 27.90),These four sub links are the key links of intravenous thrombolysis.Endovascular therapy patients completed physical examination to arrive at MRI room(OR = 31.73,95% CI: 6.68～150.69),arrived at MRI room to begin MRI examination(OR = 4.34,95% CI: 1.61 ～ 11.72),completed MRI examination to sign intra-arterial treatment agreement(OR = 65.73,95% CI: 8.18 ～528.26),signed agreement to arrive at catheter room(OR = 16.25,95% CI: 4.79 ～55.13),arrived at catheter room to complete patient placement(OR = 22.50,95% CI:4.79 ～ 55.13),these five sub links are the key links of endovascular treatment.The analysis of the reasons for the delay of each rescue link showed that there was no special imaging machine,the delay in signing the treatment agreement between the patients and their families,the poor connection between the emergency rescue room and the imaging center,the emergency rescue room and the catheter room and other factors prolonged the rescue time.2.The results of literature research show that the main methods of in-hospital rescue for acute ischemic stroke are intravenous thrombolysis and intravascular treatment,but the rescue locations of the whole reperfusion process are relatively scattered.The above results show that the multi location transfer in the rescue process affects the rescue efficiency of patients,and it is urgent to build a one-stop rescue process to change the phenomenon of multi location transfer of patients and improve the rescue efficiency.3.Five themes were identified in the qualitative interview:(1)The efficiency of hospital rescue in AIS needs to be improved;(2)Reperfusion therapy was delayed;(3)There are many emergencies,so it is difficult to smooth the process;(4)Looking forward to the use of one-stop rescue equipment in Hospital for the Acute ischemic stroke patients;(5)Stroke nurses in catheterization room are generally competent for one-stop rescue work.4.The expert group meeting determined that the nurse in the catheter room should be responsible for the monitoring of patients’ vital signs,assist patients to complete imaging examination,and assist doctors to complete intravenous thrombolysis or intravascular treatment of acute ischemic stroke.The expert authority coefficient Cr value was 0.885.5.In the experimental stage,the control group was included in 127 patients with acute ischemic stroke who were admitted to emergency hospital for reperfusion treatment from January to December 2019.The experimental group included 126 patients who received reperfusion treatment in emergency admission from May to December 2020,of which 47 were thrombolytic,35.0(29.00,49.00)minutes from admission to receiving intravenous thrombolysis,79 cases were treated in the vessel,and the median time from admission to femoral artery puncture was 64.0(49.00,86.00)minutes.The median number of patients admitted to receiving intravenous thrombolysis decreased from 51.5min in the control group to 35.0min in the experimental group,and the median number from admission to femoral artery puncture was reduced from 107.0min in the control group to 64.0min in the experimental group.The proportion of patients admitted to the hospital to receive intravenous thrombolysis for no more than 60 min was increased from 83.3% in the control group to 91.5% of the experimental group.The proportion of patients admitted to femoral artery puncture for no more than 90 minutes increased from 38.0% in the control group to 82.3% of the experimental group,the difference was statistically significant(P < 0.0001).Before and after the implementation of one-stop rescue process,the patients who were treated with intravenous thrombolysis had statistical significance in Stroke Scale scores of National Institutes of health immediately after thrombolysis(P = 0.039),and there was no statistical difference in the scores at discharge(P = 0.331).The score of improved Rankin scale in 90 days after the treatment of the patients with vascular treatment was no more than 2 points,and there was no significant difference in the number of days,expenses and symptomatic bleeding(P > 0.1).After the implementation of one-stop rescue process,the satisfaction of stroke team to catheterization nurses was higher than that before the implementation of one-stop rescue process(P < 0.002).Conclusions1.Through the current situation investigation,literature research,qualitative research,expert group meeting,combined with hospital hardware facilities,this study constructed the one-stop station rescue process in acute ischemic stroke hospital,which changed the status of multi location transfer from admission to blood flow reperfusion,improved the rescue efficiency,improved the prognosis of patients,and improved the satisfaction of acute ischemic stroke hospital rescue members to the catheter room nurses.2.The experience of establishing catheter room nurses as the main force of blood flow reperfusion nursing for acute ischemic stroke patients is worth promoting. |
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