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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2016 | Original research

Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol

Authors: Iiro Heikkilä, Hanna Kuusisto, Alexandr Stolberg, Ari Palomäki

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

Abstract

Background

Tissue plasminogen activator (tPA) treatment for acute ischaemic stroke (AIS) should be given as soon as possible, preferably within 60 min after arrival at hospital. There is great variation in door-to-needle times (DNTs) internationally, nationally and even within the same hospital. Various strategies for improving treatment delays have been presented. The role of emergency physicians (EPs) in treating AIS has been under discussion in recent years. Emergency Medicine (EM) officially became a specialty in Finland in 2013. Practical education of EPs in Kanta-Häme Central Hospital began in October 2012, together with reorganization of the in-hospital treatment path for AIS patients. The main change was shifting the on-call duty regarding stroke patients from internists or neurologists to EPs after the third quarter of 2013.

Methods

This was a retrospective study. The data, concerning the characteristics of tPA-treated patients, DNTs and onset-to-treatment times (OTTs) was collected from electronic and paper records. The period studied was 1 year before and 1 year during reorganization, i.e. 2012 and 2013.

Results

During the study period a total of 64 tPA treatments were given, 31 before and 33 during reorganization. The median DNT was 54 min in 2012, while it was 28 min in 2013 (p < 0.001). The median OTTs were 139 and 101 min before and during the start of reorganization, respectively (p < 0.001).

Conclusions

Both total and in-hospital delays in the treatment of ischaemic stroke were shortened significantly during reorganization. Emergency physicians are able to treat AIS patients within international time guidelines. Success was based on scrutinized reorganization and good cooperation between neurologists, EPs and radiologists.

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Title: Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol
Authors: Iiro Heikkilä
Hanna Kuusisto
Alexandr Stolberg
Ari Palomäki
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2016
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-016-0237-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Stroke thrombolysis given by emergency physicians cuts in-hospital delays significantly immediately after implementing a new treatment protocol

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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