Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings.
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Auteurs : Anne W. Alexandrov [États-Unis] ; Kisha C. Coleman [États-Unis] ; Paola Palazzo [France] ; Reza Bavarsad Shahripour [États-Unis] ; Andrei V. Alexandrov [États-Unis]Source :
- 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.
DOI: 10.1177/1756285616648061
PubMed: 27366237
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Address: UTHSC CON 920 Madison, Suite 532, Memphis, TN 38163</wicri:regionArea></affiliation></author><author><name sortKey="Coleman, Kisha C" sort="Coleman, Kisha C" uniqKey="Coleman K" first="Kisha C" last="Coleman">Kisha C. Coleman</name><affiliation wicri:level="2"><nlm:affiliation>Blue Cross/Blue Shield of Alabama, Birmingham, Alabama.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Alabama</region></placeName><wicri:cityArea>Blue Cross/Blue Shield of Alabama, Birmingham</wicri:cityArea></affiliation></author><author><name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, Poitiers University Hospital, Poitiers, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Neurology, Poitiers University Hospital, Poitiers</wicri:regionArea></affiliation></author><author><name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name><affiliation wicri:level="1"><nlm:affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN</wicri:regionArea></affiliation></author><author><name sortKey="Alexandrov, Andrei V" sort="Alexandrov, Andrei V" uniqKey="Alexandrov A" first="Andrei V" last="Alexandrov">Andrei V. Alexandrov</name><affiliation wicri:level="1"><nlm:affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2016">2016</date><idno type="RBID">pubmed:27366237</idno><idno type="pmid">27366237</idno><idno type="doi">10.1177/1756285616648061</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></publicationStmt><sourceDesc><biblStruct><analytic><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><affiliation wicri:level="1"><nlm:affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center & Australian Catholic University, Sydney, Australia. Address: UTHSC CON 920 Madison, Suite 532, Memphis, TN 38163, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center & Australian Catholic University, Sydney, Australia. Address: UTHSC CON 920 Madison, Suite 532, Memphis, TN 38163</wicri:regionArea></affiliation></author><author><name sortKey="Coleman, Kisha C" sort="Coleman, Kisha C" uniqKey="Coleman K" first="Kisha C" last="Coleman">Kisha C. Coleman</name><affiliation wicri:level="2"><nlm:affiliation>Blue Cross/Blue Shield of Alabama, Birmingham, Alabama.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Alabama</region></placeName><wicri:cityArea>Blue Cross/Blue Shield of Alabama, Birmingham</wicri:cityArea></affiliation></author><author><name sortKey="Palazzo, Paola" sort="Palazzo, Paola" uniqKey="Palazzo P" first="Paola" last="Palazzo">Paola Palazzo</name><affiliation wicri:level="1"><nlm:affiliation>Department of Neurology, Poitiers University Hospital, Poitiers, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Neurology, Poitiers University Hospital, Poitiers</wicri:regionArea></affiliation></author><author><name sortKey="Shahripour, Reza Bavarsad" sort="Shahripour, Reza Bavarsad" uniqKey="Shahripour R" first="Reza Bavarsad" last="Shahripour">Reza Bavarsad Shahripour</name><affiliation wicri:level="1"><nlm:affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN</wicri:regionArea></affiliation></author><author><name sortKey="Alexandrov, Andrei V" sort="Alexandrov, Andrei V" uniqKey="Alexandrov A" first="Andrei V" last="Alexandrov">Andrei V. Alexandrov</name><affiliation wicri:level="1"><nlm:affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN</wicri:regionArea></affiliation></author></analytic><series><title level="j">Therapeutic advances in neurological disorders</title><idno type="ISSN">1756-2856</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">27366237</PMID><DateCreated><Year>2016</Year><Month>07</Month><Day>01</Day></DateCreated><DateCompleted><Year>2016</Year><Month>07</Month><Day>01</Day></DateCompleted><DateRevised><Year>2017</Year><Month>02</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Print">1756-2856</ISSN><JournalIssue CitedMedium="Print"><Volume>9</Volume><Issue>4</Issue><PubDate><Year>2016</Year><Month>Jul</Month></PubDate></JournalIssue><Title>Therapeutic advances in neurological disorders</Title><ISOAbbreviation>Ther Adv Neurol Disord</ISOAbbreviation></Journal><ArticleTitle>Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings.</ArticleTitle><Pagination><MedlinePgn>304-9</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1177/1756285616648061</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">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.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">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.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">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 versus 9.5, respectively). Overall sICH rate was 3.3% (n = 10) and SH rate was 2.9 (n = 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 (p = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Alexandrov</LastName><ForeName>Anne W</ForeName><Initials>AW</Initials><AffiliationInfo><Affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center & Australian Catholic University, Sydney, Australia. Address: UTHSC CON 920 Madison, Suite 532, Memphis, TN 38163, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Coleman</LastName><ForeName>Kisha C</ForeName><Initials>KC</Initials><AffiliationInfo><Affiliation>Blue Cross/Blue Shield of Alabama, Birmingham, Alabama.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Palazzo</LastName><ForeName>Paola</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Neurology, Poitiers University Hospital, Poitiers, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shahripour</LastName><ForeName>Reza Bavarsad</ForeName><Initials>RB</Initials><AffiliationInfo><Affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alexandrov</LastName><ForeName>Andrei V</ForeName><Initials>AV</Initials><AffiliationInfo><Affiliation>Stroke Team and Mobile Stroke Unit, University of Tennessee Health Science Center, Memphis, TN, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>05</Month><Day>15</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Ther Adv Neurol Disord</MedlineTA><NlmUniqueID>101480242</NlmUniqueID><ISSNLinking>1756-2856</ISSNLinking></MedlineJournalInfo><CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000197</RefSource><PMID Version="1">17943737</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>N Engl J Med. 1995 Dec 14;333(24):1581-7</RefSource><PMID Version="1">7477192</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Clin Chest Med. 2009 Mar;30(1):103-22, 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Version="1">22153858</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Acad Emerg Med. 2006 Nov;13(11):1109-13</RefSource><PMID Version="1">17015412</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Stroke Res Treat. 2013;2013:510481</RefSource><PMID Version="1">23766928</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Stroke. 2013 Nov;44(11):3044-9</RefSource><PMID Version="1">24065713</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Circulation. 2012 Sep 11;126(11):1408-28</RefSource><PMID Version="1">22893607</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Crit Care Clin. 2009 Jan;25(1):239-50, x</RefSource><PMID Version="1">19268805</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Stroke. 2013 Mar;44(3):870-947</RefSource><PMID Version="1">23370205</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Crit Care Nurs Q. 2006 Oct-Dec;29(4):326-41</RefSource><PMID Version="1">17063100</PMID></CommentsCorrections></CommentsCorrectionsList><OtherID Source="NLM">PMC4916527</OtherID><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">cost savings</Keyword><Keyword MajorTopicYN="N">functional outcome</Keyword><Keyword MajorTopicYN="N">safety</Keyword><Keyword MajorTopicYN="N">stroke units</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>7</Month><Day>2</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>7</Month><Day>2</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2016</Year><Month>7</Month><Day>2</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">27366237</ArticleId><ArticleId 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