Analysis and Improvement of Time Frames Management for Ischemic Stroke Services in the Emergency Room at Budi Medika Hospital, Bandar Lampung

Authors

  • Luther Theng Universitas Respati Indonesia
  • Yanuar Jak Respati Indonesia University

DOI:

https://doi.org/10.46799/jhs.v5i8.1347

Keywords:

ED, ischemic stroke, time frames

Abstract

Stroke is a catastrophic disease and a major health problem both in Indonesia and in the world. Stroke causes a high number of morbidities and mortalities. The philosophy of stroke"Time Is Brain", it requires good time frames management according to the world guidelines related to ischemic stroke services in emergency departments (ED). The design of the study is a quantitative descriptive with retrospective method within the period from January to December 2023, continued qualitatively a mix methodf explanatory sequential sequential. The number of samples is 150 which meets the inclusion criteria. Quantitative analysis with SPSS V29 for mac and quantitative with NVIVO 14. The Median of door to triage time at study point was 1(1-5) minutes, door to physician 2 (0-10) minutes, Door to CT scan 19.5 (2 -50) minutes, Door To CT interpretation wa 20.5 (2-200) minutes and Door To Drug was 63 (12-267) minutes. Logistics regression analysis of time frames showed that the most significant result was door to CT scan (OR:14.5,95%CI5.3-39.4,p<0.001). Moderated Regression Analysis (MRA) showed significant time frame influences p<0.001 and R2 96% with ischemic stroke service in IGD. To provide the good performance of Door to drug time60 minutes requires good time frames management, role of five (5) M management (man, method, material, machine and money) and good stroke code implementation.

References

Pickles, B. A. (2018). Impact of Emergency Room Meetings on Improvement of Door-to-Needle Times in Acute Ischemic Stroke Patients: A Single Center's Experience. Northern Clinics of Istanbul. https://doi.org/10.14744/nci.2017.00378

Hennebry, J., Stoneman, S., Jones, B., Bambrick, N., Stroiescu, A., Crosbie, I., & Mulcahy, R. (2022). Quality improvement project to improve patient outcomes by reducing door to CT and door to needle time and increasing appropriate referrals for endovascular thrombectomy. In BMJ Open Quality (Vol. 11, Issue 1). BMJ Publishing Group. https://doi.org/10.1136/bmjoq-2021-001429

Jackson, C. A., Sudlow, C. L. M., & Mishra, G. D. (2018). Education, sex and risk of stroke: A prospective cohort study in New South Wales, Australia. BMJ Open, 8(9). https://doi.org/10.1136/bmjopen-2018-024070

Kleindorfer, D.O., Towfighi, A., Chaturvedi, S., Cockroft, K.M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W.N., Kittner, S.J., Leira, E.C., Lennon, O. ., Meschia, J.F., Nguyen, T.N., Pollak, P.M., Santangeli, P., Sharrief, A.Z., Smith, S.C., Turan, T.N., & Williams, L.S. (2021). 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke, 52(7). https://doi.org/10.1161/STR.0000000000000375

Liang, X., Gao, W., Xu, J., Saymuah, S., Wang, Feng, L., & Li, S. (2022). Triage Nurse-Activated Emergency Evaluation Reduced Door-to-Needle Time in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Evidence-Based Complementary and Alternative Medicine, 2022. https://doi.org/10.1155/2022/9199856

Liao, P.H., Chu, W., & Ho, C.S. (2022). An Analysis of Waiting Time for Emergency Treatment and Optimal Allocation of Nursing Manpower. Healthcare (Switzerland), 10(5). https://doi.org/10.3390/healthcare10050820

Naknoi, S., Li, J., ramasoota, P., Liu, X., Chen, L., Phuanukoonnon, S., Soonthornworasiri, N., & Kaewboonchoo, O. (2023). Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16784-4

Powers, W.J., Rabinstein, A.A., Ackerson, T., Adeoye, O.M., Bambakidis, N.C., Becker, K., Biller, J., Brown, M., Demaerschalk, B.M., Hoh, B., Jauch, E.C., Kidwell , C.S., Leslie-Mazwi, T.M., Ovbiagele, B., Scott, P.A., Sheth, K.N., Southerland, A.M., Summers, D.V., & Tirschwell, D.L. (2019). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 50(12). https://doi.org/10.1161/STR.0000000000000211

Rasyid, A., Kurniawan, M., Mesiano, T., Hidayat, R., Rilianto, B., & Harris, S. (2022). Performance of door-to-CT time of code stroke in Indonesian tertiary referral center hospital. Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 58(1). https://doi.org/10.1186/s41983-022-00583-6

Rochmah, TN, Rahmawati, IT, Dahlui, M., Budiarto, W., & Bilqis, N. (2021). Economic burden of stroke disease: A systematic review. In International Journal of Environmental Research and Public Health (Vol. 18, Issue 14). MDPI. https://doi.org/10.3390/ijerph18147552

Roy-O'Reilly, M., Mccullough, L.D., & Royal, M. (2018). Age and Sex Are Critical Factors in Ischemic Stroke Pathology Age and Sex in Ischemic Stroke Age and Sex Are Critical Factors in Ischemic Stroke Pathology. https://doi.org/10.1210/en.2018-00465/5051605

Sayed, M.J.E., El-Eid, G.R., Saliba, M., Jabbour, R., & Hitti, E.A. (2015). Improving emergency department door to doctor time and process reliability: A successful implementation of lean methodology. Medicine (United States), 94(42), e1679. https://doi.org/10.1097/MD.0000000000001679

Singh, R.R., Yadav, P.K., & Yadav, S. (2023). Management Strategies for Overcrowding in Emergency Medicine Departments: A Narrative Review. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2023/61518.18333

Sugiyono. (2022). Management Research Methods. Alphabeta Publishers.

Xian, Y. (2011). Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality. JAMA, 305(4), 373. https://doi.org/10.1001/jama.2011.22

Yi, X., Luo, H., Zhou, J., Yu, M., Chen, X., Tan, L., Wei, W., & Li, J. (2020). Prevalence of stroke and stroke related risk factors: A population based cross sectional survey in southwestern China. BMC Neurology, 20(1). https://doi.org/10.1186/s12883-019-1592-z

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Published

2024-08-25