Multimodal strategy in the successful implementation of a stroke unit in a community hospital.
OBJECTIVE
Thrombolysis in stroke remains underutilized in daily practice. We analyzed the impact of a multimodal strategy on the rate of thrombolysis and specific procedure times during the implementation of a community hospital stroke unit.


METHODS
During a period of 2 years before and after implementation of a stroke unit, we prospectively recorded all patients with thrombolysis and specific procedure times. Calculated door-to-needle time (DNT), door-to-CT time (DCT) and CT-to-needle time (CNT) were analyzed. All structural changes before and after the implementation were analyzed.


RESULTS
The number of patients with thrombolysis increased from 24 in 2005-2006 (4.8% of all admitted patients with ischemic stroke) to 95 in 2007-2008 (12.8%). DNT was significantly reduced from 62.2±36.1 to 38.5±22.2 min (P<0.001). DCT remained unchanged at 10.3±9.5 to 10.4±13.9 min (P=0.974), whereas CNT improved from 45.7±23.1 to 28.3±20.3 min (P=0.001). Several structural changes concerning staff, logistics, procedures and laboratory were identified which contributed to decreasing DNT.


CONCLUSIONS
A multimodal strategy including several structural changes enables the successful implementation of a community hospital stroke unit offering rapid access to thrombolysis with a very short DNT.
Etgen
T
T
Department of Neurology, Klinikum Traunstein, Cuno-Niggl-Strasse 3, Traunstein,Germany. thorleif.etgen@klinikum-traunstein.de
Freudenberger
T
T
Schwahn
M
M
Rieder
G
G
Sander
D
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005858:Germany; D019538:Health Care Surveys / Q000379:methods; D006764:Hospitals, Community / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data / Q000639:trends; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data / Q000639:trends; D010348:Patient Care Team / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods; D011787:Quality of Health Care / Q000706:statistics & numerical data; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014187:Transportation of Patients; D016896:Treatment Outcome; D055815:Young Adult
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator