Triage Nurse-Activated Emergency Evaluation Reduced Door-to-Needle Time in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis
Xiao Liang, Wenhui Gao, Jiali Xu, Sara Saymuah, Xiaojie Wang, Jing Wang, Wenbo Zhao, Xiurong Xing, Changyuan Wang, Fangyan Liu, Lei Feng, Sijie Li
Abstract
Background and Purpose. Shorter door-to-needle time (DNT) is associated with a better outcome in acute ischemic stroke (AIS) patients who accept intravenous thrombolysis. We aimed to explore whether triage nurse-activated emergency evaluation would reduce DNT compared with doctor-activated emergency evaluation in AIS patients treated with intravenous thrombolysis who failed to use emergency medical services (EMSs). Methods. This was a retrospective analysis in a general hospital emergency department in Beijing, China. 212 adult AIS patients treated with thrombolysis who failed to use EMSs were included. In addition to DNT, door-to-vein open time (DVT), door-to-blood sample deliver time (DBT), and 7-day NIHSS scores were evaluated. Results. 137 (64.6%) patients were in the triage nurse-activated group and 75 (35.4%) patients were in the doctor-activated group. The DNT of the triage nurse-activated group was significantly reduced compared with the doctor-activated group (28 (26, 32.5) min vs. 30 (28, 40) min, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>p</a:mi> <a:mo>=</a:mo> <a:mn>0.001</a:mn> </a:math> ). DNT less than 45 min was seen in 95.6% of patients in the triage nurse-activated group and 84% of patients in the doctor-activated group ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>p</c:mi> <c:mo>=</c:mo> <c:mn>0.011</c:mn> </c:math> , OR 3.972, 95% CI 1.375–11.477). In addition, DVT (7 (4, 10) min vs. 8 (5, 12) min, <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>=</e:mo> <e:mn>0.025</e:mn> </e:math> ) and DBT (15 (13, 21) min vs. 19 (15, 26) min, <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo>=</g:mo> <g:mn>0.001</g:mn> </g:math> ) of the triage nurse-activated group were also shorter than those of the doctor-activated group ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>p</i:mi> <i:mo><</i:mo> <i:mn>0.05</i:mn> </i:math> ). The 7-day NIHSS scores were not statistically different between the two groups. Conclusions. Triage nurse-activated urgent emergency evaluation could reduce the door-to-needle time, which provides a feasible opportunity to optimize the emergency department service for AIS patients who failed to use emergency medical services.