Door-in-Door-Out Time of 60 Minutes for Stroke With Emergent Large Vessel Occlusion at a Primary Stroke Center

Philip M.C. Choi, Andrew H. Tsoi, Alun L. Pope, Shelton Leung, Tanya Frost, Poh Sien Loh, Ronil V. Chandra, Henry Ma, Mark Parsons, Peter Mitchell, Helen M. Dewey

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and Purpose- Rapid reperfusion with mechanical thrombectomy in ischemic strokes with emergent large vessel occlusions leads to significant reduction in morbidity and mortality. The door-in-door-out (DIDO) time is an important metric for stroke centers without an on-site mechanical thrombectomy service. We report the outcome of a continuous quality improvement program to improve the DIDO time since 2015. Methods- Retrospective analysis of consecutive patients transferred out from a metropolitan primary stroke center for consideration of mechanical thrombectomy between January 1, 2015, and October 31, 2018. Clinical records were interrogated for eligible patients with DIDO times and reasons for treatment delays extracted. Results- One hundred thirty-three patients were transferred over the 46-month period. Median DIDO time reduced by 14% per year, from 111 minutes interquartile range (IQR, 98- 142) in 2015 to 67 minutes (IQR, 55-94) in 2018. A median DIDO time of 59 minutes (IQR, 51-80) was achieved in 2018 during working hours (0800-1700 hours). Overall, 65 patients had no documented delays (49%) with a median DIDO time of 75 minutes (IQR, 54-93) and 103 minutes (IQR, 75-143) in those with at least one delay factor documented. Conclusions- A median DIDO time of <60 minutes can be achieved in a primary stroke center.

Original languageEnglish
Pages (from-to)2829-2834
Number of pages6
JournalStroke
Volume50
Issue number10
DOIs
Publication statusPublished - Oct 2019

Keywords

  • benchmarking
  • ischemia
  • quality improvement
  • reperfusion
  • thrombectomy

Cite this

Choi, Philip M.C. ; Tsoi, Andrew H. ; Pope, Alun L. ; Leung, Shelton ; Frost, Tanya ; Loh, Poh Sien ; Chandra, Ronil V. ; Ma, Henry ; Parsons, Mark ; Mitchell, Peter ; Dewey, Helen M. / Door-in-Door-Out Time of 60 Minutes for Stroke With Emergent Large Vessel Occlusion at a Primary Stroke Center. In: Stroke. 2019 ; Vol. 50, No. 10. pp. 2829-2834.
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title = "Door-in-Door-Out Time of 60 Minutes for Stroke With Emergent Large Vessel Occlusion at a Primary Stroke Center",
abstract = "Background and Purpose- Rapid reperfusion with mechanical thrombectomy in ischemic strokes with emergent large vessel occlusions leads to significant reduction in morbidity and mortality. The door-in-door-out (DIDO) time is an important metric for stroke centers without an on-site mechanical thrombectomy service. We report the outcome of a continuous quality improvement program to improve the DIDO time since 2015. Methods- Retrospective analysis of consecutive patients transferred out from a metropolitan primary stroke center for consideration of mechanical thrombectomy between January 1, 2015, and October 31, 2018. Clinical records were interrogated for eligible patients with DIDO times and reasons for treatment delays extracted. Results- One hundred thirty-three patients were transferred over the 46-month period. Median DIDO time reduced by 14{\%} per year, from 111 minutes interquartile range (IQR, 98- 142) in 2015 to 67 minutes (IQR, 55-94) in 2018. A median DIDO time of 59 minutes (IQR, 51-80) was achieved in 2018 during working hours (0800-1700 hours). Overall, 65 patients had no documented delays (49{\%}) with a median DIDO time of 75 minutes (IQR, 54-93) and 103 minutes (IQR, 75-143) in those with at least one delay factor documented. Conclusions- A median DIDO time of <60 minutes can be achieved in a primary stroke center.",
keywords = "benchmarking, ischemia, quality improvement, reperfusion, thrombectomy",
author = "Choi, {Philip M.C.} and Tsoi, {Andrew H.} and Pope, {Alun L.} and Shelton Leung and Tanya Frost and Loh, {Poh Sien} and Chandra, {Ronil V.} and Henry Ma and Mark Parsons and Peter Mitchell and Dewey, {Helen M.}",
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Door-in-Door-Out Time of 60 Minutes for Stroke With Emergent Large Vessel Occlusion at a Primary Stroke Center. / Choi, Philip M.C.; Tsoi, Andrew H.; Pope, Alun L.; Leung, Shelton; Frost, Tanya; Loh, Poh Sien; Chandra, Ronil V.; Ma, Henry; Parsons, Mark; Mitchell, Peter; Dewey, Helen M.

In: Stroke, Vol. 50, No. 10, 10.2019, p. 2829-2834.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Door-in-Door-Out Time of 60 Minutes for Stroke With Emergent Large Vessel Occlusion at a Primary Stroke Center

AU - Choi, Philip M.C.

AU - Tsoi, Andrew H.

AU - Pope, Alun L.

AU - Leung, Shelton

AU - Frost, Tanya

AU - Loh, Poh Sien

AU - Chandra, Ronil V.

AU - Ma, Henry

AU - Parsons, Mark

AU - Mitchell, Peter

AU - Dewey, Helen M.

PY - 2019/10

Y1 - 2019/10

N2 - Background and Purpose- Rapid reperfusion with mechanical thrombectomy in ischemic strokes with emergent large vessel occlusions leads to significant reduction in morbidity and mortality. The door-in-door-out (DIDO) time is an important metric for stroke centers without an on-site mechanical thrombectomy service. We report the outcome of a continuous quality improvement program to improve the DIDO time since 2015. Methods- Retrospective analysis of consecutive patients transferred out from a metropolitan primary stroke center for consideration of mechanical thrombectomy between January 1, 2015, and October 31, 2018. Clinical records were interrogated for eligible patients with DIDO times and reasons for treatment delays extracted. Results- One hundred thirty-three patients were transferred over the 46-month period. Median DIDO time reduced by 14% per year, from 111 minutes interquartile range (IQR, 98- 142) in 2015 to 67 minutes (IQR, 55-94) in 2018. A median DIDO time of 59 minutes (IQR, 51-80) was achieved in 2018 during working hours (0800-1700 hours). Overall, 65 patients had no documented delays (49%) with a median DIDO time of 75 minutes (IQR, 54-93) and 103 minutes (IQR, 75-143) in those with at least one delay factor documented. Conclusions- A median DIDO time of <60 minutes can be achieved in a primary stroke center.

AB - Background and Purpose- Rapid reperfusion with mechanical thrombectomy in ischemic strokes with emergent large vessel occlusions leads to significant reduction in morbidity and mortality. The door-in-door-out (DIDO) time is an important metric for stroke centers without an on-site mechanical thrombectomy service. We report the outcome of a continuous quality improvement program to improve the DIDO time since 2015. Methods- Retrospective analysis of consecutive patients transferred out from a metropolitan primary stroke center for consideration of mechanical thrombectomy between January 1, 2015, and October 31, 2018. Clinical records were interrogated for eligible patients with DIDO times and reasons for treatment delays extracted. Results- One hundred thirty-three patients were transferred over the 46-month period. Median DIDO time reduced by 14% per year, from 111 minutes interquartile range (IQR, 98- 142) in 2015 to 67 minutes (IQR, 55-94) in 2018. A median DIDO time of 59 minutes (IQR, 51-80) was achieved in 2018 during working hours (0800-1700 hours). Overall, 65 patients had no documented delays (49%) with a median DIDO time of 75 minutes (IQR, 54-93) and 103 minutes (IQR, 75-143) in those with at least one delay factor documented. Conclusions- A median DIDO time of <60 minutes can be achieved in a primary stroke center.

KW - benchmarking

KW - ischemia

KW - quality improvement

KW - reperfusion

KW - thrombectomy

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U2 - 10.1161/STROKEAHA.119.025838

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JF - Stroke

SN - 0039-2499

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