Standardized Protocol Studied for Timely Treatment of ELVO Stroke Patients
July 24, 2018—Findings from a study presented at the Society of NeuroInterventional Surgery’s (SNIS) 15th Annual Meeting held July 23–26 in San Francisco, California, demonstrated that developing a standardized stroke protocol of neurointerventional teams meeting suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of < 60 minutes. The study, "Door to Revascularization in Less than 60 Minutes: A Cost and Benefit Analysis," was led by investigator Donald Frei, MD.
As noted in the study, standardized protocols for imaging and transport to the angiography suite and standardization of the thrombectomy procedure help save time. However, the most important time savings come from having a neurointerventional team meet the patient when they arrive in the emergency department. A five-person team includes one registered nurse (RN), two technologists, one anesthesiologist, and one neurointerventionalist.
An additional observation was that although rapid endovascular thrombectomy helps patients with ELVO achieve the best outcomes, standardizing stroke protocols to ensure timely and safe care does come at a cost. In the SNIS announcement, Dr. Frei stated, “Level 1 trauma centers require trauma surgeons and anesthesiologists to be in-house 24/7. By requiring level 1 stroke centers to do the same, we could potentially help more ELVO patients make full recoveries.”
As summarized in the SNIS announcement, the study evaluated 1,162 ELVO alerts met by the neurointerventional team. Of these, 314 patients (27%) underwent thrombectomy. In cases in which thrombectomy was not performed, the RN and technologists are paid 2 hours each of overtime pay, averaging to a total cost of more than $200,000 in overtime pay annually for the salaried staff. This does not include physician time spent.
Dr. Frei concluded, "This study shows that stroke systems of care can and should be streamlined to ensure the best possible outcomes for patients. The associated costs also suggest that in-house neurointerventional teams at hospitals may be the most effective option for rapid and safe care. The additional annual cost in overtime pay for the team is far outweighed by the huge benefit in decreasing the costs of lifelong disability because many more patients can return to independence.”