Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding
Document Type
Journal ArticlePublication Date
2017-01-01Keywords
crowdingemergency service
hospital
stroke
time-to-treatment
Cardiovascular Diseases
Emergency Medicine
Nervous System Diseases
Metadata
Show full item recordAbstract
BACKGROUND AND PURPOSE: National guidelines call for door-to-imaging time (DIT) within 25 minutes for suspected acute stroke patients. Studies examining factors that affect DIT have focused primarily on stroke-specific care processes and patient-specific factors. We hypothesized that emergency department (ED) crowding is associated with longer DIT. METHODS: We conducted a retrospective investigation of 1 year of consecutive patients in our prospective Code Stroke registry, which included all ED stroke team activations. The registry and electronic health records were abstracted for 27 potential predictors of DIT, including patient, stroke care process, and ED operational factors. We fit a multivariate logistic regression model and calculated odds ratios and 95% confidence intervals. Second, we constructed a random forest recursive partitioning model to cross-validate our findings and explore the proportional importance of each category of predictor. Our primary outcome was the binary variable of DIT within the 25-minute goal. RESULTS: A total of 463 patients met inclusion criteria. In the regression model, ED occupancy rate emerged as a predictor of DIT, with odds ratio of 0.83 (95% confidence interval, 0.75-0.91) of DIT within 25 minutes per 10% absolute increase in ED occupancy rate. The secondary analysis estimated that ED operational factors accounted for nearly 14% of the algorithm's prediction of DIT. CONCLUSIONS: ED crowding is associated with reduced odds of meeting DIT goals for acute stroke. In addition to improving stroke-specific processes of care, efforts to reduce ED overcrowding should be considered central to optimizing the timeliness of acute stroke care.Source
Stroke. 2017 Jan;48(1):49-54. doi: 10.1161/STROKEAHA.116.015131. Epub 2016 Nov 17. Link to article on publisher's site
DOI
10.1161/STROKEAHA.116.015131Permanent Link to this Item
http://hdl.handle.net/20.500.14038/28428PubMed ID
27856953Notes
Co-authors Evangelia Murray and Marguerite Youngren are medical students at UMass Medical School.
Related Resources
ae974a485f413a2113503eed53cd6c53
10.1161/STROKEAHA.116.015131