Implementation of the Helsinki Model at West Tallinn Central Hospital

Ischemic stroke is defined as neurological deficit caused by brain infarction. The intravenous tissue plasminogen activator, alteplase, is an effective treatment. However, efficacy of this method is time dependent. An important step in improving outcome and increasing the number of patients receivin...

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Bibliographic Details
Published in:	Medicina (Kaunas, Lithuania) Vol. 58; no. 9; p. 1173
Main Authors:	Gross-Paju, Katrin, Thomson, Ulvi, Adlas, Raul, Jaakmees, Helle, Kannel, Karin, Mallene, Sandra Marii, Mironenko, Svetlana, Reitsnik, Agnes, Vares, Ain, Ütt, Sandra
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 29-08-2022 MDPI
Subjects:	Care and treatment Cellular telephones Child Collaboration Contraindications door-to-needle time Dosage and administration Electronic health records Emergency medical care Emergency service Emergency Service, Hospital Fibrinolytic Agents - therapeutic use Hospitals Humans Magnetic resonance imaging Medical records Mortality outcome Patients pre-hospital care service provision Statistical analysis Stroke Stroke (Disease) Stroke - drug therapy Teams thrombolysis Thrombolytic Therapy - methods Time Factors Tissue plasminogen activator Tissue Plasminogen Activator - therapeutic use Treatment Outcome Estonia service provision door-to-needle time pre-hospital care thrombolysis quality of care stroke outcome
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Summary:	Ischemic stroke is defined as neurological deficit caused by brain infarction. The intravenous tissue plasminogen activator, alteplase, is an effective treatment. However, efficacy of this method is time dependent. An important step in improving outcome and increasing the number of patients receiving alteplase is the shortening of waiting times at the hospital, the so-called door-to-needle time (DNT). The comprehensive Helsinki model was proposed in 2012, which enabled the shortening of the DNT to less than 20 min. : The aim of this study was to analyze the transferability of the suggested model to the West Tallinn Central Hospital (WTCH). : Since the first thrombolysis in 2005, all patients are registered in the WTCH thrombolysis registry. Several steps following the Helsinki model have been implemented over the years. : The results demonstrate that the number and also the percent of thrombolysed stroke patients increased during the years, from a few thrombolysis annually, to 260 in 2021. The mean DNT dropped significantly to 33 min after the implementation of several steps, from the emergency medical services (EMS) prenotification with a phone call to the neurologists, to the setting-up of a thrombolysis team based in the stroke unit. Also, the immediate start of treatment using a computed tomography table was introduced. : In conclusion, several implemented steps enabled the shortening of the DNT from 30 to 25.2 min. Short DNTs were achieved and maintained only with EMS prenotification.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1648-9144 1010-660X 1648-9144
DOI:	10.3390/medicina58091173