Ciclo de melhoria no atendimento de pacientes com acidente vascular encefálico isquêmico

Abstract

Introduction: Cerebral Vascular Accident (CVA) is a highly prevalent disease, considered the second most frequent etiology of mortality. The ischemic subtype is the most common and, if not treated quickly and effectively, produces permanent sequelae and disability. One of the most effective treatment modalities is intravenous thrombolysis. Intervening in the level of improvement in the quality and safety of services implies a reduction in time, with consequent repercussions in terms of efficiency and performance of services. Objective: To evaluate the impacts on the door-to-needle, door-to-tomography and door-to-laboratory time of patients with Ischemic Cerebrovascular Accident (CVA) undergoing thrombolytic treatment, after implementing improvements in the flow of initial patient care in the emergency room of a hospital. Objective: To evaluate the impacts on the doorto-needle, door-to-tomography and door-to-laboratory time of patients with Ischemic Cerebrovascular Accident (CVA) undergoing thrombolytic treatment, after implementing improvements in the flow of initial patient care in the emergency room of a hospital. Methodology: Retrospective observational cohort study in which it was evaluated whether there was a decrease in the needle door, tomography door and laboratory door time after application of cycles of improvements in the flow of initial care to patients with ischemic stroke by the management team of the institution. The study population consisted of all patients undergoing thrombolytic therapy from November 2021 to May 2023. From the application of the Brainstorming tool with the multidisciplinary team, opportunities for improvements in the flow of initial care for patients with ischemic stroke were detected. to thrombolytic therapy. The findings were inserted into the Ishikawa diagram to define the root causes of the problems raised. After strategic meetings with multidisciplinary teams, the implementation of improvement cycles was defined: implementation of sound warning after admission of a patient candidate for thrombolysis, performance of thrombolysis in the red room and allocation of thrombolysis beds. After establishing the monitoring of door-to-needle, door tomography and laboratory door time indicators through trend/control graphs in order to manage the thrombolysis protocol. Data were obtained from the institution's healthcare risk management sector database. The database in question does not have any information/identification of the participants. Data collection and analysis took place in August and September 2023. Results and discussion: After the application of the improvement cycle, there was a 36% reduction in the door tomography time, 11% in the needle door time and 4% in the laboratory door time. However, only the door tomography time showed sustained improvement until the end of the analyzed period, therefore requiring periodic analysis and management of the indicator with the teams responsible for the processes. Conclusion: The implementation of the audible warning associated with changes in the patient care flow in the neurological window brought effectiveness and efficiency to the process by reducing doorto-mography and needle-door times.