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4. Ambulance waiting and associated work flow improvement strategies: a pilot study to improve door-in-door-out time for thrombectomy patients in a primary stroke center.

Author

Gaynor, Eva, Griffin, Emma, Thornton, John, Alderson, Jack, Martin, Mary, O'Driscoll, Anne, Daly, Patricia, O'Donnell, Cathal, Conroy, Ronan, and O'Brien, Paul

Subjects
EVALUATION of medical care, PILOT projects, HOSPITAL emergency services, AMBULANCES, TIME, TRANSPORTATION of patients, WORKFLOW, STROKE units, QUALITY assurance, STROKE patients, THROMBECTOMY
Abstract

Background Rapid access to thrombectomy for patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) is critical for improving outcome. A major challenge for the 'drip and ship' model is reducing the door-in-door-out time (DIDO). We propose a new protocol with the aim of reducing DIDO, without adversely affecting emergency service usage time. Methods Consecutive patients with suspected LVO AIS admitted to a Primary Stroke Center (PSC) from October 2018 to January 2021 were included. On arrival, the ambulance crew remained with the patient. Following immediate clinical and radiological evaluation, patients were transferred to the Comprehensive Stroke Center (CSC) by the same waiting crew. Key time metrics were collected and compared with historical data prior to the new protocol. Results 27 patients had an LVO amenable for mechanical thrombectomy during the time period. There was a significant reduction in the DIDO times compared with the historical group (median 45 min vs 96 min; p<0.0001). There was no significant difference in ambulance usage time between the two time periods (median 53 min vs 45 min; p=0.530). There was an increase in ambulance usage time in FAST- positive patients not for transfer in the pilot group compared with FAST-positive patients not for transfer in the historical group (27 min vs 58 min; p<0.001). In addition, door-to-needle times (24 min vs 40 min; p=0.018) and door-to-CT times (11 min vs 25 min; p<0.0001) improved between the two groups. Conclusion Our data show a significant reduction in the DIDO for patients transferred for thrombectomy, with no adverse effects on ambulance usage time. [ABSTRACT FROM AUTHOR]

Published
2022
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9. Secondary Risk Factor Management 5-Years Post Ischaemic Stroke : The Aspire-S2 Study

Author

Gaynor, Eva

Abstract

Background:Numerous guidelines have been published outlining evidence-based best practice in secondary stroke prevention, including optimal target control of risk factors. Despite these guidelines failure to achieve these recommendations in clinical practice is common. Aims: The primary aim of this study was to prospectively assess secondary prevention profiles of Irish ischaemic stroke patients at 5-years and compare them to that measured at 6-months.Methods: The original ASPIRE S-1 study analysed 256 patients for secondary risk factors at 6-months post ischemic stroke. This study, ASPIRE S2, followed this cohort of patients five years on. Secondary risk factors were measured included clinic blood pressure, 24 hour ambulatory blood pressure measurements and fasting bloods (lipids, glucose, HBA1C in diabetic patients).Results: 108 patients were followed-up at 5-years post-ischaemic stroke. The 5-year mortality rate was 24.6% (n=63). Comparative analysis of risk factors between the two time-points (6-months and 5-years post-stroke) showed an increase in the prevalence of cardiovascular risk factors (atrial fibrillation, hypertension, hypercholesterolaemia). Only 34% (n=36) of patients achieved a clinic SBP of

Published
2017

12. Interarm blood pressure difference in a post-stroke population

Author

Gaynor, Eva, primary, Brewer, Linda, additional, Mellon, Lisa, additional, Hall, Patricia, additional, Horgan, Frances, additional, Shelley, Emer, additional, Dolan, Eamonn, additional, Hickey, Anne, additional, Bennett, Kathleen, additional, and Williams, David J., additional

Published
2017
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