ORCID Profile
0000-0002-8765-073X
Current Organisations
Royal Melbourne Hospital
,
Northern Hospital
,
Swinburne University
,
Deakin University
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Related Links
Publications
Door-in-door-out times for patients with large vessel occlusion ischaemic stroke being transferred for endovascular thrombectomy: a Victorian state-wide study
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJNO-2022-000376
Abstract: Time to reperfusion is an important predictor of outcome in ischaemic stroke from large vessel occlusion (LVO). For patients requiring endovascular thrombectomy (EVT), the transfer times from peripheral hospitals in metropolitan and regional Victoria, Australia to comprehensive stroke centres (CSCs) have not been studied. To determine transfer and journey times for patients with LVO stroke being transferred for consideration of EVT. All patients transferred for consideration of EVT to three Victorian CSCs from January 2017 to December 2018 were included. Travel times were obtained from records matched to Ambulance Victoria and the referring centre via Victorian Stroke Telemedicine or hospital medical records. Metrics of interest included door-in-door-out time (DIDO), inbound journey time and outbound journey time. Data for 455 transferred patients were obtained, of which 395 (86.8%) underwent EVT. The median DIDO was 107 min (IQR 84–145) for metropolitan sites and 132 min (IQR 108–167) for regional sites. At metropolitan referring hospitals, faster DIDO was associated with use of the same ambulance crew to transport between hospitals (75 (63–90) vs 124 (99–156) min, p .001) and the administration of thrombolysis prior to transfer (101 (79–133) vs 115 (91–155) min, p .001). At regional centres, DIDO was consistently longer when patients were transported by air (160 (127–195) vs 116 (100–144) min, p .001). The overall door-to-door time by air was shorter than by road for sites located more than 250 km away from the CSC. Transfer times differ significantly for regional and metropolitan patients. A state-wide database to prospectively collect data on all interhospital transfers for EVT would be helpful for future study of optimal transport mode at regional sites and benchmarking of DIDO across the state.
The quest to reduce stroke treatment delays at a Melbourne metropolitan primary stroke centre over the past two decades
Publisher: Wiley
Date: 13-06-2022
DOI: 10.1111/IMJ.15429
Abstract: Reducing door‐to‐needle time (DNT) for intravenous thrombolysis in acute ischaemic stroke can lead to improved patient outcomes. Long‐term reports on DNT trends in Australia are lacking in the setting of extension of the thrombolysis time window, addition of mechanical thrombectomy and increasing presentations. To examine 17‐year trends of DNT and identify factors associated with improved DNT at a high‐volume, metropolitan primary stroke centre. Retrospective study between 2003 and 2019 of all thrombolysis cases using departmental stroke database. Since most strategies were implemented from 2012 onwards, intervention period has been defined as period 2012–2019. Factors associated with DNT reduction were examined by regression modelling. Fifteen strategies were identified including alterations to ‘Code Stroke’ processes. One thousand, two hundred and fifty patients were thrombolysed, with 737 (58.8%) treated during the intervention period. The proportion of DNT ≤60‐min rose from average of 22.5% during 2003–2012 to 63% during 2015–2018 and 71% in 2019. However, median DNT has only marginally improved from 58 to 51 min between 2015 and 2019. Faster DNT was independently associated with two modifiable workflow factors, ‘Direct‐to‐CT’ protocol ( P 0.001) and acute stroke nurse presence ( P 0.005). Over time, treated patients were older and less independent ( P 0.001), and the number of annual stroke admissions and ‘Code Stroke’ activations have risen by fourfold and 10‐fold to 748 and 1298 by 2019 respectively. Targeted quality improvement initiatives are key to reducing thrombolysis treatment delays in the Australian metropolitan setting. Relative stagnation in DNT improvement is concerning and needs further investigation.
Using body cameras to quantify the duration of a Code Stroke and identify workflow issues: a continuous observation workflow time study
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJOPEN-2022-067816
Abstract: ‘Code Stroke’ (Code) is used in health services to streamline hyperacute assessment and treatment delivery for patients with ischaemic stroke. However, there are few studies that detail the time spent on in idual components performed during a Code. We sought to quantify the time taken for each process during a Code and investigate associations with modifiable and non-modifiable factors. Continuous observation workflow time study. Recordings of 100 Codes were performed at a high-volume primary stroke centre in Melbourne, Australia, between January and June 2020 using a body camera worn by a member of the stroke team. The main measures included the overall duration of Codes and the in idual processes within the Code workflow. Associations between variables of interest and process times were explored using linear regression models. 100 Codes were captured, representing 19.2% of all Codes over the 6 months. The median duration of a complete Code was 54.2 min (IQR 39.1–74.7). Administrative work performed after treatment is completed (median 21.0 min (IQR 9.8–31.4)) multimodal CT imaging (median 13.0 min (IQR 11.5–15.7)), and time between decision and thrombolysis administration (median 8.1 min (IQR 6.1–10.8)) were the longest components of a Code. Tenecteplase was able to be prepared faster than alteplase (median 1.8 vs 4.9 min, p=0.02). The presence of a second junior doctor was associated with shorter administrative work time (median 10.3 vs 25.1 min, p .01). No specific modifiable factors were found to be associated with shorter overall Code duration. Codes are time intensive. Time spent on decision-making was a relatively small component of the overall Code duration. Data from body cameras can provide granular data on all aspects of Code workflow to inform potential areas for improvement at in idual centres.
Related Organisations
Related Funding Activities
No related grants have been discovered for Tonya Meyrick.