Standardised stroke protocol can ensure ELVO stroke patients are treated within 60 minutes

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A new study shows that developing a standardised stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalisation time of less than 60 minutes. The study was presented at the Society of NeuroInterventional Surgery’s (SNIS) 15th Annual Meeting.

Door to Revascularisation in Less than 60 Minutes: A Cost and Benefit Analysis mentions that while standardised protocols for imaging and transport to the angiography suite, as well as a standardisation of the thrombectomy procedure, help save time, the most important time savings comes from having a neurointerventional team meet the patient when they arrive in the emergency room. The five-person team includes one registered nurse (RN), two technologists, one anaesthesiologist, and one neurointerventionalist.

“Level 1 trauma centres require trauma surgeons and anaesthesiologists to be in-house 24/7. By requiring Level 1 stroke centres to do the same, we could potentially help more ELVO patients make full recoveries,” said Donald Frei, lead author of the study and a neurointerventionalist based in Colorado, USA.

Rapid endovascular thrombectomy helps patients with ELVO achieve the best outcomes, but standardising stroke protocols to ensure timely and safe care does come at a cost. The study considered 1,162 ELVO alerts met by the neurointerventional team. Of these, 314 patients (27%) received a thrombectomy. In cases in which a thrombectomy was not performed, the RN and technologists are paid two hours each of overtime pay, averaging to a total cost of more than US$200,000 in overtime pay annually for the salaried staff.  This does not include physician time spent.

“This study shows that stroke systems of care can and should be streamlined to ensure the best possible outcomes for patients,” said Frei. “The associated costs also suggest that in-house neurointerventional teams at hospitals may be the most effective option for rapid and safe care. The additional annual cost in overtime pay for the team is far outweighed by the huge benefit in decreasing the costs of lifelong disability because many more patients can return to independence.”

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