Role of a critical pathway for door-to-CT-completion interval in the management of acute ischemic stroke patients in the emergency room
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概要
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Objective: Door-to-CT-completion interval (DCI) for acute ischemic stroke patients is one of the clinical indicators of quality assurance in an emergency room (ER). The aim was to clarify whether the critical pathway improves the DCI for acute stroke patients in the ER. Methods: The pathway describes each step in patient evaluation in sequence from the patients arrival in the ER until the brain CT is completed. Whether to use the pathway when evaluating individual patients is left to the discretion of the physician. After excluding 8 cases with insufficient data, 52 cases diagnosed with acute stroke (29 males, 69.9±12.4 y/o) in the ER between January and February 2003 were retrospectively identified. A logistic regression analysis was used to assess the impact of application of the pathway on achievement of an acceptable DCI (<25 min). Results: The pathway was applied in 21.2% of the cases included in the study, and the median DCI was reduced from 48 minutes to 22 minutes as a result (P=0.02). Comparing them with the DCI, the probability values for ambulance use, consciousness disturbance, history of stroke, and application of the pathway in univariate analyses were less than 0.10. These variables were entered into the logistic analysis, which that indicated application of the pathway was the strongest variable related to acceptable DCI (OR: 10.92, 95% CI: 1.22 to 97.96). Conclusion: Application of the pathway was associated with an improvement of the DCI. Use of the pathway will improve the quality of the process of care in the ER.
- The Keio Journal of Medicineの論文
- 2004-12-01
著者
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Honda Masanori
Department Of Internal Medicine School Of Medicine Keio University
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Kobayashi Kenji
Department Of Cardio-renal Medicine And Hypertension Nagoya City University Graduate School Of Medic
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Suzuki Masaru
Department Of Applied Physics And Chemistry The University Of Electro-communications
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IMAI Akira
Department of Earth and Planetary Science, University of Tokyo
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Suzuki Masaru
済生会宇都宮病院
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Honda M
Urawa Municipal Hospital Saitama Jpn
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OHTSUKA Shujiro
Department of Surgery, Saisei-kai Utsunomiya Hospital
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Imai Akira
Department Of Earth And Planetary Science University Of Tokyo
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Imai Akira
Department Of Neurology Saisei-kai Utsunomiya Hospital
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Imai Akira
Department Of Applied Chemistry Nagoya Institute Of Technology
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Kobayashi Kenji
Department Of Emergency Medicine Saisei-kai Utsunomiya Hospital
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Kobayashi Kenji
Departmant Of Zoology Graduate School Of Science Kyoto University
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Ohtsuka Shujiro
Department Of Surgery Saisei-kai Utsunomiya Hospital
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