Investigation And Analysis Of Thrombolytic Procedure In Acute Ischemic Stroke:Data From 60 Hospitals Of Zhejiang Province

ObjectiveInvestigate the current status of thrombolytic procedure in Acute Ischemic Stroke established in 60 Hospitals of Zhejiang Province,and analyze the influencing factors of patients' door-to-needle time(DNT)in the procedure,in order to provide evidence of establishing or optimizing thrombolytic procedure for the hospitals.MethodsA cross-sectional study was conducted to investigate the current status thrombolytic procedure in 60 hospitals from 11 districts of Zhejiang Province,using a questionnaire which included the annual number of thrombolytic therapy,a thrombolytic procedure established or not,DNT and so on.The standard average DNT is defined as less than or equal to 60 minutes according to the guideline recommendation,and further analyze its influencing factors.ResultsOf the included 60 hospitals,58(96.7%)provide intravenous thrombolysis,of which 48(80.0%)established an emergency thrombolytic procedure,however,average DNT of only 22(36.7%)hospitals reached the standard.Compared with those did not reach the standard,they had higher proportion of establishment of thrombolytic procedure(95.5%vs 75%,?2=4.004,P=0.045),emergency of neurology(68.2%vs 38.9%,x2=4.687,P=0.030),multidisciplinary team(81.8%vs 55.6%,x2=4.169,P=0.041),green channel of emergency department(95.5%vs 75%,?2=4.004,P=0.045)and radiology department(95.5%vs 75%,x2=4.004,P=.045))continuous quality improvement with quality improvement tools(81.8%vs 55.6%,?2=4.986,P=0.026)and starting thrombolysis in emergency room(81.8%vs 55.6%,x2=4.169,P=0.041),without waiting for coagulation spectrum,blood routine and other laboratory results(36.4%vs 11.1%,x2=5.307,P=0.021).The binary logistic regression analysis showed that thrombolysis in emergency room(OR=8.574,95%CI:1.555-47.279;P=0.014),multidisciplinary team cooperation(OR = 6.758,95%CI:1.200-38.067;P =0.030)and not waiting for coagulation spectrum and blood routine report results(OR=16.123,95%CI:2.363-110.028;P=0.005)were the independent factors of DNT reaching the standard.ConclusionThe overall rate of reaching the DNT standard is still low in the hospitals from Zhejiang Province.To establish or optimize an emergency thrombolytic procedure,such as setting up emergency of neurology and multidisciplinary team,opening departments of emergency and radiology green channel,starting intravenous thrombolysis in emergency room,not waiting for coagulation spectrum and blood routine report results and continuous quality improvement may shorten DNT.