Triage Nurse-Activated Emergency Evaluation Reduced Door-to-Needle Time in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Abstract

Background and Purpose. Shorter door-to-needle time (DNT) is associated with a better outcome in acute ischemic stroke (AIS) patients who accept intravenous thrombolysis. We aimed to explore whether triage nurse-activated emergency evaluation would reduce DNT compared with doctor-activated emergency evaluation in AIS patients treated with intravenous thrombolysis who failed to use emergency medical services (EMSs). Methods. This was a retrospective analysis in a general hospital emergency department in Beijing, China. 212 adult AIS patients treated with thrombolysis who failed to use EMSs were included. In addition to DNT, door-to-vein open time (DVT), door-to-blood sample deliver time (DBT), and 7-day NIHSS scores were evaluated. Results. 137 (64.6%) patients were in the triage nurse-activated group and 75 (35.4%) patients were in the doctor-activated group. The DNT of the triage nurse-activated group was significantly reduced compared with the doctor-activated group (28 (26, 32.5) min vs. 30 (28, 40) min, $p=0.001$ ). DNT less than 45 min was seen in 95.6% of patients in the triage nurse-activated group and 84% of patients in the doctor-activated group ( $p=0.011$ , OR 3.972, 95% CI 1.375–11.477). In addition, DVT (7 (4, 10) min vs. 8 (5, 12) min, $P=0.025$ ) and DBT (15 (13, 21) min vs. 19 (15, 26) min, $p=0.001$ ) of the triage nurse-activated group were also shorter than those of the doctor-activated group ( $p<0.05$ ). The 7-day NIHSS scores were not statistically different between the two groups. Conclusions. Triage nurse-activated urgent emergency evaluation could reduce the door-to-needle time, which provides a feasible opportunity to optimize the emergency department service for AIS patients who failed to use emergency medical services.