Optimization And Evaluation Of In-hospital Workflow For Acute Ischemic Stroke

Objective:Review the acute ischemic stroke treatment status and process management research both domestic and foreign.Use the process management theory as a guide to build a program of in-hospital treatment process optimization of acute ischemic stroke.Carry ou tthe program into clinical validation to evaluate the implementation effect.The result can provide the basis to shorten the time and improve the efficiency of in-hospital treatment of patients with acute ischemic stroke.Methods:Using literature research,on-site observation and qualitative interviews research to summarize the status and the link which can be optimized of in-hospital treatment of patient with acute ischemic stroke.So that we can construct a process optimization draft of in-hospital treatment of patient with acute ischemic stroke.Through the expert discussion on the draft,we established the process optimization program of in-hospital treatment of acute ischemic stroke.Use NIHSS score,modified Rankin scale score,mortality rate,symptomatic cerebral hemorrhage incidence as index to evaluate the feasibility and practicality of the process optimization program.Results:1?The study found that process management of in-hospital treatment of acute ischemic stroke focus on intravenous thrombolysis process.There is a large gap with between doemesti achievement with foreign advanced level.2.The data of site observation shows that the process of hospital treatment process is not balanced,medical staff expertise has yet to be improved,the delay of patients and family medical decision.12 cases of medical staff from Changhai Hospital of Second Military Medical University were selected and interviewed by using phenomenological approach,and Colaizzi data analysis principles were used to analyze and refine topic.Five themes were extracted : the current treatment process is more reasonable;the demand for the allocation of stroke emergency nurses;the demand for information platform construction;patient and family medical decision-making time delay;the need for enhance interdisciplinary cooperation.3.On the basis of the previous research,we established the draft for process optimization of acute ischemic stroke patients,including the allocation of stroke emergency nurses,forward venous thrombolysis site to the CT room,to diversify the disease notification,the establishment information platform,of hospital treatment process management,.we developed t he formation oft process optimization program though expert meeting4.57 patients was recruited as intervention group.In intervention group the median time of doot-to-needle was 27.5 minute in intervention group,the median time of door-to-puncture was 51 minute.69 patients was recruited as control group.Compared with the median time of doot-to-needle 41 minute,the median time of door-to puncture 78 minute of control group,there is a significantly decreased,and the difference was statistically significant(P <0.05).There was a significant difference of door-to-specialist admissions time 1 minute,door-to-image time13 minute,image-to-needle time17 minute,needle-to-puncture time 21 minute.between the two groups.(P <0.05).There was no statistically significant difference between the treatment effect of two groups(P> 0.05).Conclusion:1.Through the on-site observation,qualitative interviews and expert meetings to build an process optimization program of acute ischemic stroke hospital treatment.The clinical validation of the program effectively shorten the in-hospital treatment time.2.The process optimization of acute ischemic stroke in-hospital treatment can effectively improve the better prognosis of patients.3.Move forward venous thrombolysis site to the CT,we can further shorten the image-to-needle time.so that the hospital treatment time can achieve international advanced level.4.The treatment process which stroke first aid nurses participate in can shorten the door-to-needle time.