Neurointerventional Cross‐Training of Operating Staff Reduces Door‐to‐Puncture Times in Mechanical Thrombectomy

HomeStroke: Vascular and Interventional NeurologyVol. 2, No. 1Neurointerventional Cross‐Training of Operating Staff Reduces Door‐to‐Puncture Times in Mechanical Thrombectomy Open AccessarticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessarticlePDF/EPUBNeurointerventional Philipp Hendrix, MD, Angela M. Callahan, RN, Axel Rosengart, Karissa A. Graham, Kellie Capone, Kathryn Wright, Lisa Beckett, Heather Dicristina, Samantha Doucoure, Thomas Wagner, DNP, Christoph Griessenauer, Shamsher Dalal, Gregory Weiner, Oded Goren, MD Clemens Schirmer, PhD, MBA, FAANS, FACS, FAHA HendrixPhilipp Hendrix , Department Neurosurgery, Geisinger, Health System, Wilkes‐Barre, PA, Geisinger Danville, Search for more papers by this author CallahanAngela Callahan RosengartAxel Rosengart GrahamKarissa Graham CaponeKellie Capone WrightKathryn Wright BeckettLisa Beckett DicristinaHeather Dicristina DoucoureSamantha Doucoure WagnerThomas Wagner GriessenauerChristoph Griessenauer Research Institute Neurointervention, Paracelsus Medical University, Salzburg, Austria, DalalShamsher Dalal WeinerGregory Weiner GorenOded Goren SchirmerClemens Schirmer *Correspondence to: FAHA, Neurosurgery Neuroscience Institute, PA 18711. E‐mail: E-mail Address: [email protected] https://orcid.org/0000-0003-1743-8781 Originally published12 Jan 2022https://doi.org/10.1161/SVIN.121.000213Stroke: Neurology. 2022;2:e000213Other version(s) articleYou are viewing the most recent version article. Previous versions: January 12, 2022: Version Record thrombectomy (MT) has been shown efficacious acute large‐vessel occlusion ischemic stroke. Timely intervention is predominant predictor favorable outcomes. In past, coordinated protocols have established expedite door‐to‐needle times promptly administer intravenous tissue‐plasminogen activator eligible patients. The integration MT stroke care warranted additional efforts streamline workflows that allow timely allocation suitable patients angio suite. resource intensive requires specially trained personal such as neurointerventionalists well interventional radiology (IR) technicians. Prompt availability neurovascular team another bottleneck care, potentially delaying door‐to‐puncture MT.1, 2 Here, we sought explore between comprehensive centers serve same healthcare system rural suburban Pennsylvania but employ different neuroendovascular on‐call protocols. Center B operated service with dedicated IR technicians nurses only. contrast, center A cross‐trained operating room (OR) scrub neurointervention, eventually facilitating deployment suite MT.MethodsProspectively collected data from August 2018 July 2019 were retrospectively reviewed (IRB 2017‐0521). Baseline demographics, radiological data, workflow (last known well‐to‐door, door‐to‐puncture, puncture‐to‐revascularization) 90‐day functional outcomes assessed previously described.3 Both serving meet or exceed “Get With Guidelines” achievement measures. performed 1 hybrid OR an backup during study period.Center circulating nurses. Outside business hours, technologists nurse called up endovascular neurosurgeon. served procedures technician was in, a pulled in‐hospital on call staff.Univariable analysis carried out using chi‐square, Mann‐Whitney U, unpaired t tests, appropriate, SPSSS 25 (IBM, Armonk, NY), Prism 8 (GraphPad Software, San Diego, CA), Photoshop CS5 (Adobe, New York, NY) visualization, respectively.ResultsDuring period, 122 underwent (center A, n=40; B, n=82). Age, female sex, baseline National Institutes Stroke Scale equal among both (Figure 1A). Mean Last well‐to‐door time arriving 448±373 minutes 328±329 (P=0.072) 1B), resulting trend being tissue plasminogen (P=0.075). Door‐to‐puncture significantly shorter (58±51 minutes) compared (103±79 minutes; P=0.001), while puncture‐to‐revascularization (34±25 37±25 minutes, respectively; P=0.490, Figure 1B). Thrombolysis Cerebral Infarction scale 2b/3 revascularization rates 30‐day mortality very similar, had be A.Download figureDownload PowerPointFIGURE Comparison (A), (B) centers.DiscussionThe presented highlights neurointerventional cross‐training staff goes hand reduced when comparing pure remote model. To balance elective caseload peak hours nonpeak including night weekend calls centers, consecutive MTs period included irrespective time. effect likely pronounced outside (Monday–Friday 7 am–5 pm). These observations take into account represent summation multiple work processes.4, 5 However, parity coordination similar intrafacility distances (emergency department, suite), infrastructure, setups allowed comparison centers. training unlikely since even before pilot inherits several limitations. Yet unidentified confounders may affect results because limited sample size length. Traveled home workplace not assessed. vast majority lives within 20‐minute car ride workplace. summary, in‐house potential improve MT, translate improved clinical outcomes.Source FundingNoneDisclosuresNoneAcknowledgmentsNoneFootnotes*Correspondence protected]edu[Correction added 30 April 2022, after first online publication: copyright line changed.]References1 Menon BK, Xu H, Cox M, Saver JL, Goyal Peterson E, Xian Y, Matsuoka R, Jehan Yavagal D, et al. Components trends door treatment therapy get guidelines‐stroke hospitals. Circulation. 2019; 139:169–179.LinkGoogle Scholar2 Jadhav AP, Wilson AT, Nogueira RG, BK. Shifting bottlenecks treatment. J. Neurointerv Surg.2016; 8:1099–1100.CrossrefMedlineGoogle Scholar3 P, Chaudhary Avula V, Abedi Zand Noto Melamed I, O, CM, CJ. Outcomes mechanical early (<6‐hour) extended (≥6‐hour) window based solely noncontrast CT angiography: propensity score‐matched cohort study. AJNR Am J Neuroradiol.2021; 42:1979–1985.Google Scholar4 Frei McGraw C, McCarthy K, Whaley Bellon RJ, Loy J, Orlando Bar‐Or D. standardized protocol leads faster recanalization times. Neurointerven Surg.2017; 9:1035–1040.Google Scholar5 Schönenberger S, Weber Ungerer MN, Pfaff Schieber Uhlmann L, Heidenreich Bendszus Kieser Wick W, KEEP SIMPLEST study: improving delays periinterventional management thrombectomy—a matched pair analysis. Neurocrit Care.2019; 31:46–55.Google Scholar Back top Next FiguresReferencesRelatedDetailsCited ByGross (2022) Cross‐Training: Time Well Spent Leading Saved!, Stroke: Neurology, 2:1, Online publication date: 1-Jan-2022. 2022Vol Issue 1Article InformationMetrics © 2022 Authors. Published behalf American Heart Association, Inc., Society Neurology Wiley Periodicals LLC.This open access article under terms Creative Commons Attribution‐NonCommercial License, which permits use, distribution reproduction any medium, provided original properly cited used commercial purposes.https://doi.org/10.1161/SVIN.121.000213 Manuscript receivedOctober 1, 2021Manuscript acceptedNovember 10, 2021Originally publishedJanuary PDF download SubjectsCerebrovascular ProceduresIschemic