title: Effects of Workflow Optimization in Endovascularly Treated Stroke Patients - A Pre-Post Effectiveness Study.
abstract: Endovascular treatment of acute ischemic stroke has become standard of care for patients with large artery occlusion. Early restoration of blood flow is crucial for a good clinical outcome. We introduced an interdisciplinary standard operating procedure (SOP) between neuroradiologists, neurologists and anesthesiologists in order to streamline patient management. This study analyzes the effect of optimized workflow on periprocedural timings and its potential influence on clinical outcome. Data were extracted from a prospectively maintained university hospital stroke database. The standard operating procedure was established in February 2014. Of the 368 acute stroke patients undergoing endovascular treatment between 2008 and 2015, 278 patients were treated prior to and 90 after process optimization. Outcome measures were periprocedural time intervals and residual functional impairment. After implementation of the SOP, time from symptom onset to reperfusion was significantly reduced (median 264 min prior and 211 min after SOP-introduction (IQR 228-32 min and 161-278 min, respectively); P<0.001). Especially faster supply of imaging and prompt transfer of patients to the angiography suite contributed to this effect. Time between hospital admission and groin puncture was reduced by half after process optimization (median 64 min after versus 121 min prior to SOP-introduction (IQR 54-77 min and 96-161 min, respectively); P<0.001). Clinical outcome was significantly better after workflow optimization as measured with the modified Rankin Scale (common odds ratio (OR) 0.56; 95% CI 0.32-0.98; P = 0.038). Optimization of workflow and interdisciplinary teamwork significantly improved the outcome of patients with acute ischemic stroke due to a significant reduction of in-hospital examination, transportation, imaging and treatment times.
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Katharina
authors.identifier: http://orcid.org/0000-0003-4367-1667
authors.initials: K
authors.lastname: Schregel
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Behme
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsogkas
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Knauth
authors.affiliation: Department of Neurology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Ilko
authors.initials: I
authors.lastname: Maier
authors.affiliation: Department of Infectiology, Helmholtz Center for Infection Research, Braunschweig, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Karch
authors.affiliation: Department of Infectiology, Helmholtz Center for Infection Research, Braunschweig, Germany.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mikolajczyk
authors.affiliation: Department of Anaesthesiology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: José
authors.initials: J
authors.lastname: Hinz
authors.affiliation: Department of Neurology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Liman
authors.affiliation: Department of Neuroradiology, University Medicine Goettingen, Goettingen, Germany.
authors.forename: Marios-Nikos
authors.initials: MN
authors.lastname: Psychogios
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D017598:Efficiency, Organizational; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D057188:Workflow
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator