Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, June 26, 2024

WVU Research: Standardized Protocols Hasten Stroke Treatment

 But did this get survivors 100% recovered? Survivors don't give a flying fuck about speed of treatment, they want to know about 100% recovery! Do you blithering idiots have two functioning neurons anywhere to rub together?

If you don't measure 100% recovery, you'll never get there.

“What's measured, improves.” So said management legend and author Peter F. Drucker 

You'll want 100% recovery when you are the 1 in 4 per WHO that has a stroke! Explain how you're going to get to 100% recovery if you don't start that research RIGHT NOW!

WVU Research: Standardized Protocols Hasten Stroke Treatment

West Virginia University

West Virginia University research illustrates that American Heart Association and American Stroke Association guidelines are effective at speeding up hospitals' response times for stroke treatment and can be mastered even by members of "ad hoc" medical teams that assemble rapidly on the fly.

Swift stroke treatment is critical, so when a stroke patient arrives at an emergency room, specialists from across hospital departments — EMS, neurologists, pharmacists, physicians, nurses, radiologists and technicians — rush to coordinate a team response. AHA and ASA guidelines, or "best practices," put specific limits on how much time can optimally elapse between the onset of ischemic stroke, in which blood flow to the brain is blocked, and subsequent events like arrival at the hospital and delivery of an infusion.

However, experts have questioned whether the communication of those best practices helps medical teams that assemble temporarily and whose members don't typically collaborate. A Journal of Operations Management paper by WVU John Chambers College of Business and Economics associate professor Bernardo Quiroga and coauthors answers that question using data about more than 8,000 patients who received stroke care at a large hospital (not WVU Hospitals) between 2009 and 2017.

"'Time is brain' for stroke victims," Quiroga explained. "Blocked blood flow to the brain kills almost two million neurons a minute, so your life or ability to walk or talk hinges on how quickly multiple professionals coordinate to restore blood flow. If you're lucky, you're treated within the first hour of symptom onset. Better yet, you receive a shot of Tissue Plasminogen Activator, which dissolves clots. TPA works better the earlier it's given and usually isn't effective after 4.5 hours."

In 2010, the AHA and ASA launched Target: Stroke, a program that identifies stroke care best practices and standardizes each step in the process. Participating hospitals reduced median treatment times from 79 minutes in 2009 to 51 minutes in 2017, but it wasn't clear if that improvement was driven by adherence to best practices or by clinicians learning through repetition as they handled more stroke cases.

To figure that out, the researchers investigated whether repeated "learning by doing" decreased the hospital's stroke care time. Then, they evaluated whether deliberate, "induced" learning and implementation of AHA/ASA best practices decreased the time further.

Learning through repetition worked. The more strokes the hospital treated, the faster it responded. For each doubling of cumulative stroke alerts, "door-to-needle time" — the time to get patients from the hospital door to a TPA infusion — decreased by 10.2%.

Best practices also worked. Specifically, the researchers examined two best practices: the Helsinki Model protocol, which directs that EMS staff keep stroke patients on the stretcher for transport to the CT room rather than transferring them to ER beds; and the Rapid Administration of TPA protocol, which requires the pharmacist to be in the CT room with TPA before completion of the CT scan. Those protocols significantly reduced the hospital's door-to-needle time beyond improvements from repetition-based learning.

According to Quiroga's coauthor and former PhD student Brandon Lee, that matters because it demonstrates the efficacy of best practices and shows ad hoc teams learning guidelines and implementing them long-term.

However, Lee emphasized the importance of the presence of the hospital's stroke advisory committee, which set targets, evaluated stroke teams' performances and gave feedback.

Without similar "countermeasures to organizational forgetting," Quiroga acknowledged that best practices aren't always sustainable, especially on ad hoc teams.

"In the case of the best practice indicated by the Helsinki Model, compliance is difficult because the hospital needs to coordinate with multiple independent EMS systems. Some EMS providers may be reluctant to commit resources to extended time in the CT room, and EMS staff turnover may lead to forgetting," Quiroga said.

Lee added, "Overall, because ad hoc teams are fluid, information sharing is harder. And when a group of people don't know each other well, group learning slows. But although ad hoc teams learn more slowly, we determined they still learn."

The research also assessed whether neurologists' abilities to meet time goals were affected by their recent experiences treating prior stroke patients.

"As team leaders, neurologists can have an outsized influence on performance," Quiroga said. "Because other members of the ad hoc team aren't familiar with each other, they lean on their leader."

But data showed stroke teams improving response times regardless of how many stroke cases the neurologist had treated individually or what the neurologist's recent success rate was. Quiroga said that's good news.

"The implication is that learning and sustaining best practices ensures an even quality of care for patients, regardless of individual neurologists' experience levels."

/Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.
 

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