Background: Good outcomes in stroke care require swift diagnostics, for which magnetic resonance imaging (MRI) as first-line brain imaging is superior to computed tomography scans. Reduced length of stay (LOS) in hospital and emergency departments (ED) may optimize resource use. Fast-track stroke MRI was implemented as the primary imaging technique for suspected stroke, in the ED at Copenhagen University Hospital-Herlev and Gentofte in 2020.
Objectives: We aimed to describe and compare LOS, MRI utilization, and the rate of strokes versus stroke-mimicking conditions on the stroke ward, before and after the implementation of fast-track MRI.
Design and method: In this cross-sectional study, we used data from admissions to the neurologic ED and associated non-comprehensive stroke unit. We compared two time periods, that is, January 1-December 31, 2019, and January 1-December 31, 2020, before and after the implementation of fast-track stroke MRI.
Results: There were 6650 admissions before and 7201 after implementation of fast-track stroke MRI. After implementation, we observed reductions in average LOS in hospitals from 56.0 to 38.6 h (p < 0.001), and LOS in ED from 9.17 to 8.63 h (p < 0.001). The use of inpatient MRI increased significantly, and the rate of acute ischemic stroke patients on the ward increased yet the rate of non-strokes remained unchanged. The association between shorter admissions and access to MRI remained (odds ratio 1.81, p < 0.001), after adjusting for sex, age, weekend admissions, and lockdown periods.
Conclusion: Fast-track stroke MRI in ED associated with reduced LOS in hospital.
Keywords: admission length; emergency department; magnetic resonance imaging; stroke; stroke diagnostics; triage.
Emergency department logistics after implementation of magnetic resonance brain scans, as a first-line imaging technique, for suspected stroke Why was the study done? Swift diagnostics is essential, as stroke treatment is time sensitive. Brain imaging is a substantial part of stroke workups, as it allows doctors to distinguish blood clots from brain hemorrhages. Occasionally, imaging is a bottle neck ahead of treatment. Traditionally, CT (computed tomography) has been used in stroke care, but MRI (magnetic resonance imaging) is diagnostically superior, as it helps visualize brain tissue affected by a clot, even very early on. However, MRI is more time consuming than CT. I.e., for stroke imaging, not only the type of scan is of interest, but also associated logistics. What did the researchers do? We evaluated the change in hospital logistics, associated with a change in our first-line imaging technique for stroke - from CT in 2019 to MRI in 2020. We measured lengths of stay, both in hospital overall, and in the emergency department, rates of readmissions, and what diagnoses our patients had, when they were discharged after a full workup on the stroke ward (i.e., either a stroke, or something that mimics a stroke). What did the researchers find? Out of 13851 admissions, 6550 were admitted in 2019, when CT was the initial imaging technique, and 7201 in 2020, after MRI-first had been implemented. We observed a reduction in the average length of stay in hospital, from 56 hours before MRI-first and 38 hours after. The average length of stay in the emergency department also changed from 9.1 to 8.6 hours, after MRI implementation. The rate of readmission to the emergency department remained unchanged. Additionally, the rate of patients with strokes admitted to the stroke ward increased, indicating that we could identify stroke-mimicking conditions prior to admission. What do the findings mean? Implementing an MRI-first approach for suspected stroke, allowed us to improve our logistics, both on the stroke-ward, but also in the emergency department, whilst maintaining diagnostic accuracy.
© The Author(s), 2024.