Hendrix et al present an interesting, concise, and meaningful analysis from the Geisinger health system that elegantly illustrates reduced door‐to‐puncture times at a center with cross‐trained operating room staff. 1 Working at 2 comprehensive stroke centers, the authors have thoughtfully compared slightly differing models to illustrate the advantage of cross‐trained, in‐house operating room staff. Specifically, at center A, an in‐house operating room circulation nurse and scrub technician were always available while 1 additional technologist was called in. At center B, 2 on‐call technologists and an on‐call nurse were called in. Center A was a lower‐volume center over the evaluated 12‐month period than B (n=40 versus 82). Nevertheless, remarkably, door‐to‐puncture times were significantly shorter at center A (mean, 58 versus 103 minutes; P=0.001). As expected, procedural times were similar, as were successful revascularization rates, across the 2 centers. Despite a trend toward longer mean last known well‐to‐door time of patients at center A, the authors comment on a trend of more favorable 90‐day outcomes (modified Rankin scale score of 0–2, 55% versus 39%) for patients treated at center A.
It has been clearly recognized that neurointerventional team mobilization can serve as a time‐limiting factor in providing expedient interventional stroke care. 2 This is a particularly germane concern off hours; as referenced, a study by Menon et al evaluating factors influencing door–to–first pass times found nonregular treatment hours as a significant risk factor for longer times. 3 In turn, delays can adversely impact outcome. As illustrated in a post hoc analysis of MR CLEAN, every hour increase from stroke onset to start of endovascular therapy resulted in a 5.3% decreased probability of functional independence. 4
Having in‐house, cross‐trained staff is an obvious approach to address the challenge of swift time to treatment at a suboptimal time of day. Hendrix et al clearly demonstrate a direct benefit on door‐to‐puncture times, even though strokes at all times of day were included in the analysis. 1 Along a parallel line of benefit, at our institution, selected intensive care unit nurses are cross‐trained in neurointervention and serve as an immediate in‐house resource at all hours. We have also found an added advantage in continuity of care after the procedure as well.
The authors are commended on this thoughtful study and resourceful analysis of 2 centers in their system. Cross‐training is time well spent and results in time (and likely brain) saved!
Disclosures
Dr Gross is a consultant for Medtronic and Microvention.
[Correction added on 08 March 2022, after first online publication: The last line in the Disclosure section that was inadvertently added has been removed.]
The opinions expressed in this article are not necessarily those of the American Heart Association, or the Society of Vascular and Interventional Neurology.
[Correction added on 30 April 2022, after first online publication: The copyright line was changed.]
References
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