Introduction: Metrics of imaging-to-puncture and to-reperfusion were recently found to be associated with clinical outcomes of endovascular thrombectomy for acute ischemic stroke. However, measures for improving workflow within hospitals to achieve better timing results are largely unexplored for endovascular therapy. The aim of this study is to examine our single center experience with a novel smartphone application developed as a part of a workflow process improvement plan.
Methods: We developed a smartphone application to expedite conversations via an encrypted program and to provide all team members with a real-time window from stroke onset until puncture time. The effects of the application on the timing of endovascular therapy were evaluated with a secondary analysis of our single-center cohort of acute stroke patients that underwent endovascular therapy. The primary outcome of our analysis was imaging-to-puncture time. Secondary outcomes included: stroke onset-to-imaging and puncture-to-reperfusion time. We assessed outcomes pre- and post-application use with non-parametric tests for statistical significance.
Results: There were 45 patients that met our criteria for analysis among 66 consecutive patients with acute ischemic stroke who received endovascular therapy at our institution from April 2011 to March 2016. Following the use of smartphone application, imaging-to-puncture time was significantly reduced (pre-application median time: 110 min, post-application: 74 min, p=.01). There was a trend toward a better stroke onset-to-imaging and puncture-to-reperfusion times in our post-application group, however, they were not statistically different from the pre-application group.
Conclusions: Effective process improvement plans and utilizing smartphone applications can reduce treatment times for endovascular therapy in acute ischemic strokes. Further studies are needed to confirm our findings.
Patient Care: Our process improvement plan and smartphone application were effective in reducing treatment times for endovascular therapy in acute ischemic strokes. These metrics correlate with better clinical outcomes.
Learning Objectives: By the conclusion of this session, participants should be able to recognize the importance of: (1) Process improvement plans to enhance workflow metrics for endovascular therapy in acute stroke, and (2) Utilization of smartphone applications to provide a real-time window for endovascular therapy