"Stroke Clock" Could Help Streamline Care of Acute Stroke Patients

Image Provided by American Heart Association

A simple solution could cut time and streamline care for stroke patients, according to results of a randomized controlled trial conducted in Germany.

In the study, use of a large display alarm clock in a hospital’s computed tomography (CT) room contributed to more streamlined care—suggesting implementation of such an approach could help to achieve the American Heart Association/American Stroke Association’s target recommendation of 60 minutes or less from the time a stroke patient arrives to the hospital to the time of clot-busting treatment.

"Time is brain. Minutes are easily lost in acute stroke management, despite standard protocols," said study author Klaus Fassbender, MD, professor of neurology at Saarland University Medical Center in Homburg, Germany, in a statement. "The stroke alarm clock is a low-cost intervention and an efficient way to quickly deliver life-saving treatment to acute stroke patients."

With the goal of identifying cost-effective means of improving acute stroke management, Fassbender and more than a dozen colleagues sought to determine whether a feedback-demanding stroke clock could help streamline care. With this in mind, investigators designed a randomized controlled study to assess whether a large display alarm clock installed in the CT room, which is where admission, diagnostic work-up and intravenous thrombolysis occurred, at the Saarland University Medical Center.

The alarm clock installed in the room was designed to provided alarms at the end of 3 specific time periods. The first time period lasted 15 minutes, the second lasted 20, and the third lasted 30 minutes. The first time period marked the amount of time it should take to complete the neurological exam, the second time period represented the amount of time it should take to complete CT scanning and international normalized ratio determination by point-of-care (POC) laboratory, and the third time period represented the time it should take to begin intravenous thrombolysis.

Physicians were required to provide feedback in the form of pressing a button when the alarm sounded. Investigators pointed out the alarm could be avoided by pressing the button prior to the time period ending.

The primary end point of the study was time to therapy decision, which investigators defined as the end of all guideline-recommended diagnostic work-up required for decision-making for or against reanalyzing treatments. Secondary end points for the study included time for door-to-end of neurological examination, end-of-POC laboratory, end-of-native CT, end-of-CT angiography, and, if indicated, start of intravenous thrombolysis and thrombectomy, and achievement of recanalization.

In total, 107 patients were included in the trial. Of these, 56 were randomized to the alarm clock group and 51 were randomized to standard care. Investigators pointed out demographic and medical characteristics, including final diagnoses, were similar between the study arms.

Upon analysis, results indicated time from door to end of all indicated diagnostic work-up (treatment decision time; 16.73 vs 26.00 minutes, P <.001), end of neurological examination (7.28 vs 10.00 minutes, P <.001), end of CT (11.17 vs 14.00 minutes, P=.002), end of CT angiography (14.00 vs 17.17 minutes, P=.001), end-of-POC laboratory testing (12.14 vs 20.00 minutes, P <.001), and start of intravenous thrombolysis (18.83 vs 47.00 minutes, P=.016) were improved for patients randomized to the alarm clock group.

However, investigators noted the there was no significant difference in time to start of thrombectomy and functional outcomes at day 90 between the study arms. In the aforementioned statement, Fassbender noted the study was not designed to evaluate long-term outcomes and noted the need for larger studies to confirm the effect of the clock on outcomes.

"A limitation of this study was its size. We need more patients to determine whether accelerated acute stroke management with the clock translates to less death and disability long-term,” Fassbender added.

This study, “Effects of a Feedback-Demanding Stroke Clock on Acute Stroke Management,” was published in Stroke.