Publication: Implantación de un plan de actuación para reducir los tiempos de atención intrahospitalarios de los pacientes con ictus agudo: "cada minuto cuenta"
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2019-08-02
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Universidad Complutense de Madrid
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Abstract
Los últimos metanálisis publicados sobre trombólisis intravenosa (TIV) continuan demostrando que el tiempo hasta el tratamiento es el factor más importante para el pronóstico funcional del paciente en el ictus isquémico agudo. Por eso es fundamental gestionar de forma correcta cada minuto desde el inicio de los síntomas hasta el tratamiento.Dada la heterogeneidad de los protocolos intrahospitalarios, no es infrecuente que se pierda un tiempo muy valioso dentro de los hospitales. Sin embargo en los últimos años han sido publicados resultados de protocolos de actuación "ultrarrápidos" que han conseguido reducir el tiempo desde la llegada del paciente al hospital hasta la administración de la TIV (tiempo Puerta-Aguja) a 20 minutos de mediana, muy por debajo de los 60 minutos e incluso de los 45 minutos recomendados en las guías terapéuticas actuales. Existe una llamada en la literatura médica a que el tiempo Puerta-Aguja se sitúe actualmente por debajo de 30 minutos ("good is not enough"). En términos de gestión sanitaria, los protocolos“ultrarrápidos” han demostrado ser coste-eficientes y el tiempo Puerta-Aguja es considerado un indicador de calidad asistencial. Sin embargo no existen datos publicados hasta el momento de protocolos intrahospitalarios equiparables en nuestro medio...
The latest metanalyzes focused on intravenous thrombolysis (IVT), continue to show that time to treatment remains the most important factor in acute ischemic stroke prognosis. Every minute lost from symptom onset to treatment can be critical. Given the heterogeneity of intrahospital protocols, it is common to loose precious time at hospitals. However, in recent years "ultra-fast" protocols have managed to reduce the time from the arrival of the patient to the hospital until the TIV administration (Door-to-Needle time, DTN) down to 20 minutes of median, under 60 minutes and even the minutes recommended in the current therapeutic guidelines.There is a calling for an aggressive update of our targets as a necessary step to improve patient care. Today we should set a Door-to-Needle benchmark at a 30-minute median ("good is not enough"). "Ultra-fast" protocols have proven to be cost-efficient and DTN time is considered an indicator of quality in health care. However, there is no published data at the moment of similar in-hospital protocols in our setting...
The latest metanalyzes focused on intravenous thrombolysis (IVT), continue to show that time to treatment remains the most important factor in acute ischemic stroke prognosis. Every minute lost from symptom onset to treatment can be critical. Given the heterogeneity of intrahospital protocols, it is common to loose precious time at hospitals. However, in recent years "ultra-fast" protocols have managed to reduce the time from the arrival of the patient to the hospital until the TIV administration (Door-to-Needle time, DTN) down to 20 minutes of median, under 60 minutes and even the minutes recommended in the current therapeutic guidelines.There is a calling for an aggressive update of our targets as a necessary step to improve patient care. Today we should set a Door-to-Needle benchmark at a 30-minute median ("good is not enough"). "Ultra-fast" protocols have proven to be cost-efficient and DTN time is considered an indicator of quality in health care. However, there is no published data at the moment of similar in-hospital protocols in our setting...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 21-03-2019