Cargando…

Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City

Stroke is one of the leading causes of death and disability among adults worldwide. The World Health Organization (WHO) officially declared a COVID-19 pandemic on March 11, 2020. The first case in Mexico was confirmed in February 2020, subsequently becoming one of the countries most affected by the...

Descripción completa

Detalles Bibliográficos
Autores principales: Medina-Rioja, Raul, González-Calderón, Gina, Saldívar-Dávila, Sergio, Estrada Saúl, Alexander, Gayón-Lombardo, Erika, Somerville-Briones, Nicole, Calleja-Castillo, Juan Manuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020365/
https://www.ncbi.nlm.nih.gov/pubmed/35463140
http://dx.doi.org/10.3389/fneur.2022.831735
_version_ 1784689522402918400
author Medina-Rioja, Raul
González-Calderón, Gina
Saldívar-Dávila, Sergio
Estrada Saúl, Alexander
Gayón-Lombardo, Erika
Somerville-Briones, Nicole
Calleja-Castillo, Juan Manuel
author_facet Medina-Rioja, Raul
González-Calderón, Gina
Saldívar-Dávila, Sergio
Estrada Saúl, Alexander
Gayón-Lombardo, Erika
Somerville-Briones, Nicole
Calleja-Castillo, Juan Manuel
author_sort Medina-Rioja, Raul
collection PubMed
description Stroke is one of the leading causes of death and disability among adults worldwide. The World Health Organization (WHO) officially declared a COVID-19 pandemic on March 11, 2020. The first case in Mexico was confirmed in February 2020, subsequently becoming one of the countries most affected by the pandemic. In 2020, The National Institute of Neurology of Mexico started a Quality assurance program for stroke care, consisting of registering, monitoring and feedback of stroke quality measures through the RES-Q platform. We aim to describe changes in the demand for stroke healthcare assistance at the National Institute of Neurology and Neurosurgery during the pandemic and the behavior of stroke quality metrics during the prepandemic and the pandemic periods. For this study, we analyzed data for acute stroke patients registered in the RES-Q platform, in the prepandemic (November 2019 to February 2020) and pandemic (March-December 2020) periods in two groups, one prior to the pandemic. During the pandemic, there was an increase in the total number of assessed acute stroke patients at our hospital, from 474 to 574. The average time from the onset of symptoms to hospital arrival (Onset to Door Time—OTD) for all stroke patients (thrombolyzed and non-thrombolyzed) increased from 9 h (542 min) to 10.3 h (618.3 min) in the pandemic group. A total of 135 acute stroke patients were enrolled in this registry. We found the following results: Patients in both groups were studied with non-contrast computed tomography (NNCT), computed tomography angiography (CTA), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or more frequently in the pandemic period (early carotid imaging, Holter monitoring) as needed. Treatment for secondary prevention (antihypertensives, antiplatelets, statins) did not differ. Frequency of performing and documenting the performance of NIHSS scale at arrival and early dysphagia test improved. There was an increase in alteplase use from 21 to 42% (p = 0.03). There was a decrease in door to needle time (46 vs. 39 min p = 0.30). After the implementation of a stroke care protocol and quality monitoring system, acute stroke treatment in our institution has gradually improved, a process that was not thwarted during the COVID-19 pandemic.
format Online
Article
Text
id pubmed-9020365
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-90203652022-04-21 Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City Medina-Rioja, Raul González-Calderón, Gina Saldívar-Dávila, Sergio Estrada Saúl, Alexander Gayón-Lombardo, Erika Somerville-Briones, Nicole Calleja-Castillo, Juan Manuel Front Neurol Neurology Stroke is one of the leading causes of death and disability among adults worldwide. The World Health Organization (WHO) officially declared a COVID-19 pandemic on March 11, 2020. The first case in Mexico was confirmed in February 2020, subsequently becoming one of the countries most affected by the pandemic. In 2020, The National Institute of Neurology of Mexico started a Quality assurance program for stroke care, consisting of registering, monitoring and feedback of stroke quality measures through the RES-Q platform. We aim to describe changes in the demand for stroke healthcare assistance at the National Institute of Neurology and Neurosurgery during the pandemic and the behavior of stroke quality metrics during the prepandemic and the pandemic periods. For this study, we analyzed data for acute stroke patients registered in the RES-Q platform, in the prepandemic (November 2019 to February 2020) and pandemic (March-December 2020) periods in two groups, one prior to the pandemic. During the pandemic, there was an increase in the total number of assessed acute stroke patients at our hospital, from 474 to 574. The average time from the onset of symptoms to hospital arrival (Onset to Door Time—OTD) for all stroke patients (thrombolyzed and non-thrombolyzed) increased from 9 h (542 min) to 10.3 h (618.3 min) in the pandemic group. A total of 135 acute stroke patients were enrolled in this registry. We found the following results: Patients in both groups were studied with non-contrast computed tomography (NNCT), computed tomography angiography (CTA), magnetic resonance angiography (MRA), digital subtraction angiography (DSA) or more frequently in the pandemic period (early carotid imaging, Holter monitoring) as needed. Treatment for secondary prevention (antihypertensives, antiplatelets, statins) did not differ. Frequency of performing and documenting the performance of NIHSS scale at arrival and early dysphagia test improved. There was an increase in alteplase use from 21 to 42% (p = 0.03). There was a decrease in door to needle time (46 vs. 39 min p = 0.30). After the implementation of a stroke care protocol and quality monitoring system, acute stroke treatment in our institution has gradually improved, a process that was not thwarted during the COVID-19 pandemic. Frontiers Media S.A. 2022-04-06 /pmc/articles/PMC9020365/ /pubmed/35463140 http://dx.doi.org/10.3389/fneur.2022.831735 Text en Copyright © 2022 Medina-Rioja, González-Calderón, Saldívar-Dávila, Estrada Saúl, Gayón-Lombardo, Somerville-Briones and Calleja-Castillo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Medina-Rioja, Raul
González-Calderón, Gina
Saldívar-Dávila, Sergio
Estrada Saúl, Alexander
Gayón-Lombardo, Erika
Somerville-Briones, Nicole
Calleja-Castillo, Juan Manuel
Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City
title Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City
title_full Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City
title_fullStr Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City
title_full_unstemmed Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City
title_short Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City
title_sort grace under pressure: resiliency of quality monitoring of stroke care during the covid-19 pandemic in mexico city
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020365/
https://www.ncbi.nlm.nih.gov/pubmed/35463140
http://dx.doi.org/10.3389/fneur.2022.831735
work_keys_str_mv AT medinariojaraul graceunderpressureresiliencyofqualitymonitoringofstrokecareduringthecovid19pandemicinmexicocity
AT gonzalezcalderongina graceunderpressureresiliencyofqualitymonitoringofstrokecareduringthecovid19pandemicinmexicocity
AT saldivardavilasergio graceunderpressureresiliencyofqualitymonitoringofstrokecareduringthecovid19pandemicinmexicocity
AT estradasaulalexander graceunderpressureresiliencyofqualitymonitoringofstrokecareduringthecovid19pandemicinmexicocity
AT gayonlombardoerika graceunderpressureresiliencyofqualitymonitoringofstrokecareduringthecovid19pandemicinmexicocity
AT somervillebrionesnicole graceunderpressureresiliencyofqualitymonitoringofstrokecareduringthecovid19pandemicinmexicocity
AT callejacastillojuanmanuel graceunderpressureresiliencyofqualitymonitoringofstrokecareduringthecovid19pandemicinmexicocity