Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings
Identifieur interne : 003785 ( Ncbi/Checkpoint ); précédent : 003784; suivant : 003786Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings
Auteurs : Anne W. Alexandrov ; Kisha C. Coleman ; Paola Palazzo ; Reza Bavarsad Shahripour ; Andrei V. AlexandrovSource :
- Therapeutic Advances in Neurological Disorders [ 1756-2856 ] ; 2016.
Abstract
In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients.
We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined.
We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0
IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.
Url:
DOI: 10.1177/1756285616648061
PubMed: 27366237
PubMed Central: 4916527
Affiliations:
Links toward previous steps (curation, corpus...)
- to stream Pmc, to step Corpus: 000500
- to stream Pmc, to step Curation: 000500
- to stream Pmc, to step Checkpoint: 000A13
- to stream PubMed, to step Corpus: 001C38
- to stream PubMed, to step Curation: 001C14
- to stream PubMed, to step Checkpoint: 001C14
- to stream Ncbi, to step Merge: 003785
- to stream Ncbi, to step Curation: 003785
Links to Exploration step
PMC:4916527Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings</title>
<author><name sortKey="Alexandrov, Anne W" sort="Alexandrov, Anne W" uniqKey="Alexandrov A" first="Anne W." last="Alexandrov">Anne W. Alexandrov</name>
</author>
<author><name sortKey="Coleman, Kisha C" sort="Coleman, Kisha C" uniqKey="Coleman K" first="Kisha C." last="Coleman">Kisha C. Coleman</name>
</author>
<author><name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name>
</author>
<author><name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name>
</author>
<author><name sortKey="Alexandrov, Andrei V" sort="Alexandrov, Andrei V" uniqKey="Alexandrov A" first="Andrei V." last="Alexandrov">Andrei V. Alexandrov</name>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">27366237</idno>
<idno type="pmc">4916527</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4916527</idno>
<idno type="RBID">PMC:4916527</idno>
<idno type="doi">10.1177/1756285616648061</idno>
<date when="2016">2016</date>
<idno type="wicri:Area/Pmc/Corpus">000500</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000500</idno>
<idno type="wicri:Area/Pmc/Curation">000500</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000500</idno>
<idno type="wicri:Area/Pmc/Checkpoint">000A13</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000A13</idno>
<idno type="wicri:source">PubMed</idno>
<idno type="wicri:Area/PubMed/Corpus">001C38</idno>
<idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001C38</idno>
<idno type="wicri:Area/PubMed/Curation">001C14</idno>
<idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">001C14</idno>
<idno type="wicri:Area/PubMed/Checkpoint">001C14</idno>
<idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">001C14</idno>
<idno type="wicri:Area/Ncbi/Merge">003785</idno>
<idno type="wicri:Area/Ncbi/Curation">003785</idno>
<idno type="wicri:Area/Ncbi/Checkpoint">003785</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings</title>
<author><name sortKey="Alexandrov, Anne W" sort="Alexandrov, Anne W" uniqKey="Alexandrov A" first="Anne W." last="Alexandrov">Anne W. Alexandrov</name>
</author>
<author><name sortKey="Coleman, Kisha C" sort="Coleman, Kisha C" uniqKey="Coleman K" first="Kisha C." last="Coleman">Kisha C. Coleman</name>
</author>
<author><name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name>
</author>
<author><name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name>
</author>
<author><name sortKey="Alexandrov, Andrei V" sort="Alexandrov, Andrei V" uniqKey="Alexandrov A" first="Andrei V." last="Alexandrov">Andrei V. Alexandrov</name>
</author>
</analytic>
<series><title level="j">Therapeutic Advances in Neurological Disorders</title>
<idno type="ISSN">1756-2856</idno>
<idno type="eISSN">1756-2864</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="section1-1756285616648061"><title>Background:</title>
<p>In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients.</p>
</sec>
<sec id="section2-1756285616648061"><title>Methods:</title>
<p>We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined.</p>
</sec>
<sec id="section3-1756285616648061"><title>Results:</title>
<p>We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 <italic>versus</italic>
9.5, respectively). Overall sICH rate was 3.3% (<italic>n</italic>
= 10) and SH rate was 2.9 (<italic>n</italic>
= 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for ‘avoided’ ICU days, and hospital LOS decreased significantly (<italic>p</italic>
= 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3.</p>
</sec>
<sec id="section4-1756285616648061"><title>Conclusions:</title>
<p>IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.</p>
</sec>
</div>
</front>
</TEI>
<affiliations><list></list>
<tree><noCountry><name sortKey="Alexandrov, Andrei V" sort="Alexandrov, Andrei V" uniqKey="Alexandrov A" first="Andrei V." last="Alexandrov">Andrei V. Alexandrov</name>
<name sortKey="Alexandrov, Anne W" sort="Alexandrov, Anne W" uniqKey="Alexandrov A" first="Anne W." last="Alexandrov">Anne W. Alexandrov</name>
<name sortKey="Coleman, Kisha C" sort="Coleman, Kisha C" uniqKey="Coleman K" first="Kisha C." last="Coleman">Kisha C. Coleman</name>
<name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name>
<name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name>
</noCountry>
</tree>
</affiliations>
</record>
Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Asie/explor/AustralieFrV1/Data/Ncbi/Checkpoint
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 003785 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Ncbi/Checkpoint/biblio.hfd -nk 003785 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Wicri/Asie |area= AustralieFrV1 |flux= Ncbi |étape= Checkpoint |type= RBID |clé= PMC:4916527 |texte= Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Ncbi/Checkpoint/RBID.i -Sk "pubmed:27366237" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Ncbi/Checkpoint/biblio.hfd \ | NlmPubMed2Wicri -a AustralieFrV1
This area was generated with Dilib version V0.6.33. |