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Publication
Fatores organizacionais determinantes do atraso e acesso às terapias de reperfusão no acidente vascular cerebral isquémico: revisão sistemática da literatura
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Abstract(s)
Introdução: Após o Acidente Vascular Cerebral (AVC) isquémico existe uma janela temporal para a administração de terapias de reperfusão aguda (trombólise e trombectomia). Apesar dos benefícios das terapias de reperfusão estarem inequivocamente demonstrados, o acesso às mesmas continua reduzido. A organização do atendimento ao doente com AVC está entre os principais determinantes do acesso a estas terapias. Este trabalho sistematiza o conhecimento sobre os fatores organizacionais que determinam o acesso às terapias de reperfusão aguda no AVC isquémico.
Metodologia: Revisão da literatura, através das bases de dados Pubmed e Scopus. Para pesquisa de literatura cinzenta foram usados a OpenGrey e o Google Scholar. A análise da qualidade dos estudos foi realizada pela Newcastle-Ottawa Scale.
Resultados: Foram incluídos 128 estudos. Os fatores pré-hospitalares mais prevalentes foram o atraso da ativação da emergência médica (EM), a pré-notificação, o uso da ambulância e a ausência de estratégias específicas de redução do impacto da distância do doente às unidades hospitalares. Os fatores intra-hospitalares mais frequentes foram a existência de UAVC, a localização dos meios de imagem, e a existência de protocolos específicos para o AVC. As estratégias usadas para melhorar o acesso às terapias que mostraram ser eficazes no aumento do número de doentes tratados e na redução dos tempos pré e intra-hospitalares foram: ações de educação da população e das equipas de profissionais, a existência de Unidades Móveis de AVC, a pré-notificação hospitalar e a implementação de protocolos específicos.
Conclusões: Esta revisão sistemática da literatura demonstrou que medidas de gestão e organização, na sua maioria aplicáveis em qualquer contexto, reduzem o atraso e aumentam o número de doentes que beneficiam das terapias de reperfusão aguda no AVC isquémico.
Introduction: After an acute ischemic stroke there is a crucial time window for the administration of acute reperfusion therapies (thrombolysis and thrombectomy). The benefits of reperfusion therapies are well stablished, however the access to those therapies continues to be low. The organisation of stroke care pathway is one of the main factors that determines the access to reperfusion therapies. This research work systematises the knowledge about organizational factors that regulates the access to reperfusion therapies after acute ischemic stroke. Methodology: Literature review through Pubmed and Scopus databases. OpenGrey and Google Scholar were used to search grey literature. The studies' quality analysis was based on the Newcastle-Ottawa Scale. Results: 128 studies were included in this research. Delay on medical emergency activation, pre-notification, ambulance use and lack of strategies to decrease the impact of the distance between patient and hospital were identified as the main pre-hospital factors for acute ischemic stroke reperfusion treatment access. The most common in-hospital factors studied were: Hyper-Acute Stroke Units in place, imaging room location and specific stroke treatment protocols in place. The strategies used to increase the access to reperfusion therapies that are efficiently increasing the number of patients treated and reducing pre-hospital and in-hospital delays were: education session for the population and professional teams involved, existence of mobile stroke units, hospital pre-notification and stroke treatment protocols in place. Conclusions: This literature review shows that is possible to reduce pre-hospital and in-hospital time delays and increase the number of patients receiving reperfusion therapies by implementing management and organisational measures which are mainly applicable to any hospital context.
Introduction: After an acute ischemic stroke there is a crucial time window for the administration of acute reperfusion therapies (thrombolysis and thrombectomy). The benefits of reperfusion therapies are well stablished, however the access to those therapies continues to be low. The organisation of stroke care pathway is one of the main factors that determines the access to reperfusion therapies. This research work systematises the knowledge about organizational factors that regulates the access to reperfusion therapies after acute ischemic stroke. Methodology: Literature review through Pubmed and Scopus databases. OpenGrey and Google Scholar were used to search grey literature. The studies' quality analysis was based on the Newcastle-Ottawa Scale. Results: 128 studies were included in this research. Delay on medical emergency activation, pre-notification, ambulance use and lack of strategies to decrease the impact of the distance between patient and hospital were identified as the main pre-hospital factors for acute ischemic stroke reperfusion treatment access. The most common in-hospital factors studied were: Hyper-Acute Stroke Units in place, imaging room location and specific stroke treatment protocols in place. The strategies used to increase the access to reperfusion therapies that are efficiently increasing the number of patients treated and reducing pre-hospital and in-hospital delays were: education session for the population and professional teams involved, existence of mobile stroke units, hospital pre-notification and stroke treatment protocols in place. Conclusions: This literature review shows that is possible to reduce pre-hospital and in-hospital time delays and increase the number of patients receiving reperfusion therapies by implementing management and organisational measures which are mainly applicable to any hospital context.
Description
Keywords
AVC isquémico Trombólise Trombectomia Tempo pré-hospitalar Tempo intra-hospitalar Estratégias organizacionais