Ye et al.1515 Ursi ES Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura [Master degree]. Ribeirão Preto: Universidade de São Paulo; 2005. https://doi.org/10.11606/D.22.2005.tde-18072005-095456 https://doi.org/10.11606/D.22.2005.tde-1...
8/11 |
Increased from 8.3 to 9.7% (p = 0.003) |
Increased from 0.9 to 1.6% (p < 0.001) |
DNM |
DNM |
DNM |
DNM |
Yang et al.1717 Yang SJ, Franco T, Wallace N, Williams B, Blackmore C. Effectiveness of an Interdisciplinary, Nurse Driven In-Hospital Code Stroke Protocol on In-Patient Ischemic Stroke Recognition and Management. J Stroke Cerebrovasc Dis 2019;28(12):104398. Doi: 10.1016/j.jstrokecerebrovasdis.2019.104398 https://doi.org/10.1016/j.jstrokecerebro...
5/11 |
13% before and 20% after (p = 0.99) |
6% before and 11% after (p = 0.33) |
DNM |
DNM |
DNM |
DNM |
Madhok et al.1818 Madhok DY, Keenan KJ, Cole SB, Martin C, Hemphill JC III. Prehospital and Emergency Department-Focused Mission Protocol Improves Thrombolysis Metrics for Suspected Acute Stroke Patients. J Stroke Cerebrovasc Dis 2019;28(12):104423. Doi: 10.1016/j.jstrokecerebrovasdis.2019.104423 https://doi.org/10.1016/j.jstrokecerebro...
4/8 |
DNM |
DNM |
DNM |
DNM |
0% before and 2% after (p = 0.34) |
DNM |
Ajmi et al.1919 Ajmi SC, Advani R, Fjetland L, et al. Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre. BMJ Qual Saf 2019;28(11):939-948. Doi: 10.1136/bmjqs-2018-009117 https://doi.org/10.1136/bmjqs-2018-00911...
8/11 |
DNM |
DNM |
DNM |
mRS 5-6 after 90 days reduced from 12.2 to 3.5% (p = 0.021) |
1.5% before and 0.5% after (p = 0.306) |
After 90 days it reduced from 9.1 to 3.5% (p = 0.049) |
de Belvis et al.2020 de Belvis AG, Lohmeyer FM, Barbara A, et al. Ischemic stroke: clinical pathway impact. Int J Health Care Qual Assur 2019;32 (03):588-598. Doi: 10.1108/IJHCQA-05-2018-0111 https://doi.org/10.1108/IJHCQA-05-2018-0...
6/11 |
DNM |
DNM |
Increased from M 44.7 to 65.1 days (p < 0.001) |
DNM |
DNM |
After 30 days, 8.1% before and 9.7% after (p = 0.52) |
Silsby et al.2121 Silsby M, Duma SR, Fois AF, et al. Time to acute stroke treatment in-hours was more than halved after the introduction of the Helsinki Model at Westmead Hospital. Intern Med J 2019;49(11): 1386-1392. Doi: 10.1111/imj.14290 https://doi.org/10.1111/imj.14290...
5/11 |
DNM |
DNM |
DNM |
DNM |
23.3% before and 14.3% after (p = 0.48) |
DNM |
Nguyen-Huynh et al.2222 Nguyen-Huynh MN, Klingman JG, Avins AL, et al; KPNC Stroke FORCE Team. Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System. Stroke 2018;49(01):133-139. Doi: 10.1161/STROKEAHA.117.018413 https://doi.org/10.1161/STROKEAHA.117.01...
8/11 |
Increased from 13.1 to 17.6% (p < 0.001) |
DNM |
Mdn 3.5 days before and 3.1 after (p = 0.14) |
DNM |
2.2% before and 3.8% after (p = 0.21) |
DNM |
Zakaria et al.2323 Zakaria MF, Aref H, Abd EINasser A, et al. Egyptian experience in increasing utilization of reperfusion therapies in acute ischemic stroke. Int J Stroke 2018;13(05):525-529. Doi: 10.1177/1747493017711949 https://doi.org/10.1177/1747493017711949...
8/11 |
Increased from 11.3 to 81.1%a
|
Increased from 1.9 to 13.5%a
|
DNM |
DNM |
DNM |
DNM |
Reperfusion increased from 2.7 to 12.3% (p < 0.05) |
Koge et al.2424 Koge J, Matsumoto S, Nakahara I, et al. Improving treatment times for patients with in-hospital stroke using a standardized protocol. J Neurol Sci 2017;381:68-73. Doi: 10.1016/j.jns.2017.08.023 https://doi.org/10.1016/j.jns.2017.08.02...
5/11 |
DNM |
DNM |
DNM |
mRS ≤ 2 at discharge 28.0% before and 33.3% after (p = 0.67) |
8.0% before and 3.3% after (p = 0.45) |
DNM |
Cheng et al.2525 Cheng T-J, Peng G-S, Jhao W-S, Lee J-T, Wang T-H. Nationwide “Hospital Emergent Capability Accreditation by Level-Stroke” Improves Stroke Treatment inTaiwan. J Stroke 2017;19(02):205-212 5/11 |
Increased from 3.0 to 4.5% (p < 0.05) |
DNM |
DNM |
DNM |
The overall rate was 8.6% for all years of study (p > 0.05) |
DNM |
Zinkstok et al.2525 Cheng T-J, Peng G-S, Jhao W-S, Lee J-T, Wang T-H. Nationwide “Hospital Emergent Capability Accreditation by Level-Stroke” Improves Stroke Treatment inTaiwan. J Stroke 2017;19(02):205-212 7/11 |
The annual number of thrombolysis events increased from 17 (Mdn) to 55a |
DNM |
DNM |
mRS 0–2 after 90 days 38.9% in the intervention period and 52.3% aftera
|
3.0% before and 4.4% after (p < 0.156) |
After 90 days 17.9% before and 18.2% after |
Liang et al.2626 Zinkstok SM, Beenen LF, Luitse JS, Majoie CB, Nederkoorn PJ, Roos YB. Thrombolysis in Stroke within 30 Minutes: Results of the Acute Brain Care Intervention Study. PLoS One 2016;11(11): e0166668-e0166668. Doi: 10.1371/journal.pone.0166668 https://doi.org/10.1371/journal.pone.016...
8/11 |
Increased from 37.1 to 64.5% (p = 0.026) |
DNM |
DNM |
mRS 0–2 after 90 days increased from 30.7 to 75% (p = 0.012) |
0 before, 4.4% in the 1st period and 0 in the 2nd period (p = 0.482) |
7.7 before, 4.4% in the 1st period and 0 in the 2nd period (p = 0.491) |
Li et al.2828 Li Z, Wang C, Zhao X, et al; China National Stroke Registries. Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke 2016;47(11):2843-2849. Doi: 10.1161/STROKEAHA.116.014143 https://doi.org/10.1161/STROKEAHA.116.01...
8/11 |
14.1% before and 18.3% after |
DNM |
Reduced from Mdn 14 (IQR 11-20) days to 13 (IQR 9-16) (p < 0.001) |
mRS ≤2 increased from 67.3% to 75.0% (p < 0.001) |
DNM |
Reduced from 4,1 to 1,1%(p < 0.001) |
Moran et al.2929 Moran JL, Nakagawa K, Asai SM, Koenig MA. 24/7 Neurocritical Care Nurse Practitioner Coverage Reduced Door-to-Needle Time in Stroke Patients Treated with Tissue Plasminogen Activator. J Stroke Cerebrovasc Dis 2016;25(05):1148-1152. Doi: 10.1016/j.jstrokecerebrovasdis.2016.01.033 https://doi.org/10.1016/j.jstrokecerebro...
5/11 |
(p > 0.05) |
32% before and 21% after (p = 0.16) |
DNM |
DNM |
DNM |
18% before and 12% after (p = 0.33) |
Hsieh et al.3030 Hsieh F-I, Jeng J-S, Chern C-M, et al; BTS-Stroke Investigators. Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke. PLoS One 2016;11(08): e0160426. Doi: 10.1371/journal.pone.0160426 https://doi.org/10.1371/journal.pone.016...
5/11 |
Increased from 1.2 to 4.6% (p < 0.001) |
DNM |
DNM |
DNM |
Reduced from 11.0 to 5.6% (p< 0.001) |
After 30 days 4.2% before and 4.1% after (p = 0.914) |
Ibrahim et al.3131 Ibrahim F, Akhtar N, Salam A, et al. Stroke Thrombolysis Protocol Shortens “Door-to-Needle Time” and Improves Outcomes-Experience at a Tertiary Care Center in Qatar. J Stroke Cerebrovasc Dis 2016;25(08):2043-2046. Doi: 10.1016/j.jstrokecerebrovasdis.2016.03.047 https://doi.org/10.1016/j.jstrokecerebro...
5/11 |
Increased from 4.0 to 11.8% (p < 0.0001) |
DNM |
Reduced from Mdn 7 (IQR4-13)days to 4 (IQR 2-6) days (p < 0.001) |
mRS 0-2 after 90 days increased from 47.1% to 73.3% (p < 0.001) |
5.9% before and 5.9% after (p = 0.99) |
7.8% before and 3.9% after (p = 0.23) |
Rai et al.3232 Rai AT, Smith MS, Boo S, Tarabishy AR, Hobbs GR, Carpenter JS. The ’pit-crew’ model for improving door-to-needle times in endovascular stroke therapy: a Six-Sigma project. J Neurointerv Surg 2016;8 (05):447-452. Doi: 10.1136/neurintsurg-2015-012219 https://doi.org/10.1136/neurintsurg-2015...
8/11 |
40.6% before and 43.3% after (p = 0.8) |
DNM |
DNM |
DNM |
DNM |
DNM |
Mascitelli et al.3333 Mascitelli JR, Wilson N, Shoirah H, et al. The impact of evidence: evolving therapy for acute ischemic stroke in a large healthcare system. J Neurointerv Surg 2016;8(11):1129-1135. Doi: 10.1136/neurintsurg-2015-012117 https://doi.org/10.1136/neurintsurg-2015...
6/11 |
53.1% before and 54.1% after (p = 0.938) |
Increased from 2.9 cases per month to 7.4 (p = 0.04) |
DNM |
mRS 0-2 at discharge, 21.9% before and 18.9% after (p = 0.7740) |
9.4% before and 10.8% after (p = 0.957) |
15.6% before and 10.8% after (p = 0.553) |
Kendall et al.3434 Kendall J, Dutta D, Brown E. Reducing delay to stroke thrombolysis-lessons learnt from the Stroke 90 Project. Emerg Med J 2015; 32(02):100-104. Doi: 10.1136/emermed-2013-202993 https://doi.org/10.1136/emermed-2013-202...
8/11 |
Similar between periods (p = 0.60)b |
DNM |
DNM |
DNM |
DNM |
DNM |
Atsumi et al.3535 Atsumi C, Hasegawa Y, Tsumura K, et al. Quality assurance monitoring of a citywide transportation protocol improves clinical indicators of intravenous tissue plasminogen activator therapy: a community-based, longitudinal study. J Stroke Cerebrovasc Dis 2015;24(01):183–188. Doi: 10.1016/j.jstrokecerebrovasdis.2014.08.013 https://doi.org/10.1016/j.jstrokecerebro...
8/11 |
Increased from 11.8% to 23.7% (p = 0.0135) |
DNM |
DNM |
mRS <2 after 30 days 23.5% before 34.8% after (p = 0.045) |
DNM |
DNM |
Van Schaik et al.3535 Atsumi C, Hasegawa Y, Tsumura K, et al. Quality assurance monitoring of a citywide transportation protocol improves clinical indicators of intravenous tissue plasminogen activator therapy: a community-based, longitudinal study. J Stroke Cerebrovasc Dis 2015;24(01):183–188. Doi: 10.1016/j.jstrokecerebrovasdis.2014.08.013 https://doi.org/10.1016/j.jstrokecerebro...
8/11 |
51% before and 66% aftera
|
DNM |
DNM |
DNM |
7.3% before and 4.9% after (p = 0.606) |
DNM |
Chen et al.3737 Chen C-H, Tang S-C, Tsai L-K, et al. Stroke code improves intravenous thrombolysis administration in acute ischemic stroke. PLoS One 2014;9(08):e104862. Doi: 10.1371/journal.pone.0104862 https://doi.org/10.1371/journal.pone.010...
7/11 |
Increased from 5.0% to 19.5% (p < 0.001) |
DNM |
DNM |
mRS < 2 after 90 days 44.0% before and 50.5% after (p = 0.298) |
7.7% before and 4.6% after (p = 0.285) |
6.6% before and 3.2% after (p = 0.216) |
Handschu et al.3838 Handschu R, Scibor M, Wacker A, et al. Feasibility of certified quality management in a comprehensive stroke care network using telemedicine: STENO project. Int J Stroke 2014;9(08): 1011–1016. Doi: 10.1111/ijs.12342 https://doi.org/10.1111/ijs.12342...
7/11 |
Increased from 2.6 to 8.6% (p < 0.001) |
DNM |
M 7.9 days before and 7.9 aftera
|
mRS 4-6
23.4% before and 23.3% after33 World Health Organization The top 10 causes of death. Genebra: WHO; 2020. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death https://www.who.int/news-room/fact-sheet...
|
DNM |
5.8% before and 4.6% aftera
|
Fonarow et al.3939 Fonarow GC, Zhao X, Smith EE, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA 2014;311(16):1632–1640. Doi: 10.1001/jama.2014.3203 https://doi.org/10.1001/jama.2014.3203...
7/11 |
Increased from 5.7 to 8.1% (p < 0.001) |
DNM |
Mdn 5 (IQR 3-8) before and 5 (IQR 3-7) aftera
|
DNM |
Decreased from 5.7 to 4.7% (p < 0,001) |
After the intervention, in-hospital mortality was less likely to occur (adjusted OR, 0.89 [95% CI: 0.83-0.94]) (p < 0.001) |
Ruff et al.4040 Ruff IM, Ali SF, Goldstein JN, et al. Improving door-to-needletimes: a single center validationofthetargetstrokehypothesis.Stroke2014; 45(02):504–508. Doi: 10.1161/STROKEAHA.113.004073 https://doi.org/10.1161/STROKEAHA.113.00...
6/11 |
Increased from 8.2 to 15.4% (p < 0.001) |
DNM |
DNM |
DNM |
DNM |
DNM |
Ford et al.4141 Ford AL, Williams JA, Spencer M, et al. Reducing door-to-needle times using Toyota’s lean manufacturing principles and value stream analysis. Stroke 2012;43(12):3395–3398. Doi: 10.1161/STROKEAHA.112.670687 https://doi.org/10.1161/STROKEAHA.112.67...
7/11 |
DNM |
DNM |
Mdn 4 (IQR 3-7) days before and 3 (IQR 2-6) after (p = 0.056) |
mRS < 2 after 90 days 49% before and 43% after (p = 0.34) |
3.0% before and 3.4% after (p = 1.0) |
DNM |
Lin et al.4242 Lin CB, Peterson ED, Smith EE, et al. Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circ Cardiovasc Qual Outcomes 2012;5(04):514–522. Doi: 10.1161/CIRCOUTCOMES.112.965210 https://doi.org/10.1161/CIRCOUTCOMES.112...
5/11 |
64.0% before and 73.0% aftera
|
DNM |
DNM |
DNM |
6.0% before and 5.8% after (p = 0.4020) |
DNM |
Tai et al.4343 Tai YJ, Weir L, Hand P, Davis S, Yan B. Does a ’code stroke’ rapid access protocol decrease door-to-needle time for thrombolysis? Intern Med J 2012;42(12):1316–1324. Doi: 10.1111/j.1445-5994.2011.02709.x https://doi.org/10.1111/j.1445-5994.2011...
5/11 |
Increased from 9.0% before to 17.3% aftera
|
DNM |
M 13 (SD 19) days before and M 11 (SD 17) after (p = 0.348) |
mRS < 2 at discharge 68% before and 74% after (p = 0.303) |
5% before and 7% after (p = 0.483) |
13% before and 13% after (p = 0.863) |
O'Brien et al.4444 O’Brien W, Crimmins D, Donaldson W, et al. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke. J Clin Neurosci 2012;19(02):241–245. Doi: 10.1016/j.jocn.2011.06.009 https://doi.org/10.1016/j.jocn.2011.06.0...
8/11 |
Increased from 7 to 19% (p = 0.03) |
DNM |
DNM |
DNM |
There was one case of symptomatic intracranial hemorrhage during both periods |
DNM |
Sung et al.4545 Sung S-F, Huang Y-C, Ong C-T, Chen Y-W. A Parallel Thrombolysis Protocol with Nurse Practitioners As Coordinators Minimized Door-to-Needle Time for Acute Ischemic Stroke. Stroke Res Treat 2011;2011:198518. Doi: 10.4061/2011/198518 https://doi.org/10.4061/2011/198518...
7/11 |
11.8% before and 15.1% after (p = 0.331) |
DNM |
DNM |
mRS 0-1
35% before and 28.6% after (p = 0.611)
|
12.5% before and 9.5% after (p = 1.000) |
DNM |