■中风治疗是对时间敏感的。门中门(DIDO)时间,定义为在转移医院的急诊科(ED)花费的总时间,是急性中风护理的重要质量指标。然而,关于特定过程步骤对DIDO时间的延迟和差异的贡献知之甚少。
■量化急性缺血性卒中(AIS)患者转院时的流程步骤及其与DIDO时间的关联。
■这项回顾性队列研究分析了美国心脏协会GetWithTheGuideline-Strokeregistry中的患者,AIS在2019年1月1日至2021年12月31日期间提出,并从提出的医院ED转移到另一家急性护理医院进行溶栓治疗,血管内治疗,或溶栓后护理。对2023年7月8日至10月13日的数据进行了分析。
■缺血性中风的ED护理间隔:门到成像和成像到门时间。
■主要结果是DIDO时间。进行了多元广义估计方程回归模型,以比较区间过程时间的贡献,以解释DIDO时间的变化,控制患者和医院级别的特征。
■在28887例患者中(男性占50.5%;平均[SD]年龄,68.3[14.8]年;5.5%的西班牙裔,14.7%非西班牙裔黑人,和73.2%的非西班牙裔白人),平均(SD)DIDO时间为171.4(149.5)分钟,平均(SD)成像时间为18.3(34.1)分钟,平均成像时间(SD)为153.1(141.5)分钟。在调整门到成像时间的模型中,以下与更长的DIDO时间相关:年龄80岁或以上(与18-59岁相比;5.97[95%CI,1.02-10.92]分钟),女性(5.21[95%CI,1.55-8.87]分钟),和非西班牙裔黑人种族(与非西班牙裔白人相比10.09[95%CI,4.21-15.96]分钟)。在包括成像到门时间作为协变量的模型中,DIDO按年龄和女性性别的差异变得不显著,黑色种族的差异减弱(2.32[95%CI,1.09-3.56]分钟)。
■在这项关于AIS患者院际转移的全国队列研究中,黑人种族延误了DIDO时间,年龄较大(≥80岁),女性在很大程度上被解释为成像到门的时期,建议未来的系统干预措施应针对此间隔,以减少这些差异。虽然现有的指导方针和护理资源主要集中在减少上门成像时间,在需要院间转院的AIS患者的治疗中,需要进一步关注以减少成像送院时间.
UNASSIGNED: Stroke treatment is exquisitely time sensitive. The door-in-door-out (DIDO) time, defined as the total time spent in the emergency department (ED) at a transferring hospital, is an important quality metric for the care of acute stroke. However, little is known about the contributions of specific process steps to delays and disparities in DIDO time.
UNASSIGNED: To quantify process steps and their association with DIDO times at transferring hospitals among patients with acute ischemic stroke (AIS).
UNASSIGNED: This retrospective cohort study analyzed patients in the American Heart Association Get With the Guidelines-Stroke registry with AIS presenting between January 1, 2019, to December 31, 2021, and transferred from the presenting hospital ED to another acute care hospital for evaluation of thrombolytics, endovascular therapy, or postthrombolytic care. Data were analyzed from July 8 to October 13, 2023.
UNASSIGNED: Intervals of ED care of ischemic stroke: door-to-imaging and imaging-to-door times.
UNASSIGNED: The primary outcome was DIDO time. Multivariate generalized estimating equations regression models were performed to compare contributions of interval process times to explain variation in DIDO time, controlling for patient- and hospital-level characteristics.
UNASSIGNED: Among 28 887 patients (50.5% male; mean [SD] age, 68.3 [14.8] years; 5.5% Hispanic, 14.7% non-Hispanic Black, and 73.2% non-Hispanic White), mean (SD) DIDO time was 171.4 (149.5) minutes, mean (SD) door-to-imaging time was 18.3 (34.1) minutes, and mean (SD) imaging-to-door time was 153.1 (141.5) minutes. In the model adjusting for door-to-imaging time, the following were associated with longer DIDO time: age 80 years or older (compared with 18-59 years; 5.97 [95% CI, 1.02-10.92] minutes), female sex (5.21 [95% CI, 1.55-8.87] minutes), and non-Hispanic Black race (compared with non-Hispanic White 10.09 [95% CI, 4.21-15.96] minutes). In the model including imaging-to-door time as a covariate, disparities in DIDO by age and female sex became nonsignificant, and the disparity by Black race was attenuated (2.32 [95% CI, 1.09-3.56] minutes).
UNASSIGNED: In this national cohort study of interhospital transfer of patients with AIS, delays in DIDO time by Black race, older age (≥80 years), and female sex were largely explained by the imaging-to-door period, suggesting that future systems interventions should target this interval to reduce these disparities. While existing guidelines and care resources heavily focus on reducing door-to-imaging times, further attention is warranted to reduce imaging-to-door times in the management of patients with AIS who require interhospital transfer.