Effectiveness of acute ischemic stroke patients care before and after the development of a fast track system at Suratthani Hospital

Abstract

Currently, acute ischemic stroke was a condition in which the brain stops functioning due to destruction of brain tissue and disruption of normal brain activity. The patient can lead to death or cause disability. However, if the patient receives a door-to-CT brain followed by administration of door-to-needle time (rt-PA) within 3 - 4.5 hours, it can help save their life and reduce disability. The objective of this study was to compare the effectiveness of acute ischemic stroke patient’s care, before and after the developing of a fast track system at Suratthani Hospital. This study was a retrospective descriptive study with acute ischemic stroke patients who received rt-PA treatment before the developing of stroke fast tract service system in 2018-2019 from January 2018 to December 2019, and those who received rt-PA after the development of stroke fast tract service system from January 2020 to December 2021. Samples were purposively select, consisting of 260 patients diagnosed with acute ischemic stroke patients. Data were collected through a review from the hospital's electronic medical record system includes: onset-to-ER, door-to-CT brain, door-to-needle time, ER-to-Ward, National Institutes of Health Stroke Scale and Barthel Activities of Daily Living. The results of the study showed that between before and after the developing of fast track system of acute ischemic stroke patients, the average time of door-to-needle decreased (39.53±18.54 - 28.08±15.61, minutes) and the average time of emergency room-to-ward decreased (87.75±42.37 - 47.02±34.85, minutes) with a statistically significant difference (p<0.001). As a result of after the developing of fast track system, National Institutes of Health Stroke Scale after receiving rt-PA of patients had mild impairment. The assessment of daily living activities using the Barthel Activities of Daily Living, after receiving rt-PA of patients had physically independent but not necessary normal or social independent. Therefore, if patients receive rt-PA as quickly as possible, it may reduce mortality and disability rates, leading to more effective medical treatment.