Noreen Kamal1, Eric E Smith2, Bijoy K Menon3, Muneer Eesa4, Karla J Ryckborst5, Alexandre Y Poppe6, Daniel Roy6, John Thornton7, David Williams8, Leanne K Casaubon9,10, Frank L Silver9, Kenneth Butcher11, Ashfaq Shuaib12, Jeremy L Rempel13, Tudor G Jovin14, Biggya L Sapkota15, Andrew M Demchuk1, Mayank Goyal4, Michael D Hill16. 1. Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada. 2. Department of Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada. 3. Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada. 4. Department of Radiology, Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada. 5. Calgary Stroke Program, Foothills Medical Centre, Canada. 6. CHUM Stroke Program, Department of Neurosciences, Université de Montréal, Canada. 7. Department of Neuroradiology, Beaumont Hospital, Ireland. 8. Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Ireland. 9. Division of Neurology, University of Toronto, Stroke Program University Health Network, Canada. 10. TIA and Minor Stroke (TAMS) Unit, Toronto Western Hospital, Canada. 11. Division of Neurology, University of Alberta, Canada. 12. Division of Neurology, University of Alberta, Director Stroke Program, Canada. 13. University of Alberta Hospital, Alberta Health Services, Canada. 14. Department of Neurology, University of Pittsburgh, USA. 15. Providence Health & Services, Portland, OR, USA. 16. Departments of Clinical Neurosciences, Medicine, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada.
Abstract
INTRODUCTION: Endovascular treatment of acute ischemic stroke is more effective when performed quickly. In this report, we describe quality interventions to ensure fast endovascular treatment times in the ESCAPE (Endovascular Treatment for Small Core and Anterior circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times) trial. METHODS: An "audit and feedback" intervention using webinar and letter was used to improve treatment time over the course of the trial. The time metrics were computed tomography-to-groin-puncture (target < 60 min) and computed tomography-to-first-reperfusion (target < 90 min). Each site was provided with their data for computed tomography-to-groin-puncture and computed tomography-to-first-reperfusion for all their patients that were randomized to the treatment arm, and their median time was compared to the overall median times of all sites in the trial. We assessed for changes in treatment time over the course of the trial. RESULTS: There were 165 patients enrolled into the endovascular arm from 22 sites. The computed tomography-to-groin-puncture time dropped from 57 to 47 min (p = 0.14) while computed tomography-to-reperfusion time dropped from 89 to 81 min (p = 0.48). Over the course of the trial, the absolute treatment benefit increased by 7.8% (p < 0.001). CONCLUSIONS: An "audit and feedback" intervention throughout the conduct of the ESCAPE trial was a feasible way to ensure fast treatment times. Quality improvement processes should continue as standard practice beyond the trial to encourage good patient selection and the best clinical outcomes.
INTRODUCTION: Endovascular treatment of acute ischemic stroke is more effective when performed quickly. In this report, we describe quality interventions to ensure fast endovascular treatment times in the ESCAPE (Endovascular Treatment for Small Core and Anterior circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times) trial. METHODS: An "audit and feedback" intervention using webinar and letter was used to improve treatment time over the course of the trial. The time metrics were computed tomography-to-groin-puncture (target < 60 min) and computed tomography-to-first-reperfusion (target < 90 min). Each site was provided with their data for computed tomography-to-groin-puncture and computed tomography-to-first-reperfusion for all their patients that were randomized to the treatment arm, and their median time was compared to the overall median times of all sites in the trial. We assessed for changes in treatment time over the course of the trial. RESULTS: There were 165 patients enrolled into the endovascular arm from 22 sites. The computed tomography-to-groin-puncture time dropped from 57 to 47 min (p = 0.14) while computed tomography-to-reperfusion time dropped from 89 to 81 min (p = 0.48). Over the course of the trial, the absolute treatment benefit increased by 7.8% (p < 0.001). CONCLUSIONS: An "audit and feedback" intervention throughout the conduct of the ESCAPE trial was a feasible way to ensure fast treatment times. Quality improvement processes should continue as standard practice beyond the trial to encourage good patient selection and the best clinical outcomes.
Entities:
Keywords:
Acute stroke therapy; endovascular therapy; imaging; picture to puncture; picture to reperfusion; quality improvement
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