Running with the death, Changhai Hospital used three strokes to build a "60-minute gold rescue circle"

On October 29, 2018, it was the thirteenth World Stroke Day established by the World Stroke Organization. On this day, the arterial network is certainly not idle. At the Changhai Hospital affiliated to the Naval Military Medical University (hereinafter referred to as “Changhai Hospital”), the Arterial Network witnessed the country's top stroke center, how to combine management, technology and education to create a “60-minute stroke covering the northeast of Shanghai”. Gold treatment circle."

Three obstacles to stroke treatment

In medicine, it is necessary to shorten the time of DTN (Door-to-Needle Time) for intravenous thrombolysis, and to do a good job of stroke prevention. During the visit of the arterial network, Liu Jianmin, chairman of the Department of Interventional Therapy for Oriental Cerebrovascular Diseases and director of the Department of Cerebral Vascular Surgery at Changhai Hospital, repeatedly mentioned the importance of technologies such as preaching and information technology.

In fact, the reason for the low treatment of stroke diseases in China is not in the medical level, but in many aspects.

At present, the most effective treatment for acute stroke is rapid recanalization (intravenous thrombolysis and arterial thrombectomy). After the patient's blood vessels are blocked, the intravenous thrombolysis should be quickly performed after diagnosis. In the case of massive vascular occlusion, catheter interventions should be performed as quickly as possible, and emboli should be removed. These are the most effective and preferred treatments for writing guidelines for stroke and stroke in China and the world.

Time is life, especially for stroke patients. In general, patients can only perform intravenous thrombolysis within 4.5 hours of onset. However, at present, the internal thrombolytic ratio of domestic patients is less than 10% within 2 hours after onset, and the overall thrombolytic rate is only 2%-3%, which is closely related to the long time of DTN (Door-to-Needle Time).

According to experts from Changhai Hospital, there are three reasons for the delay in DTN: First, the patient’s illness is delayed due to lack of awareness or mild symptoms, resulting in delays before the hospital. Second, after the patient arrives at the hospital, the procedure is cumbersome. Long queues cause delays in the hospital; third, stroke diseases involve many disciplines such as neurology, neurosurgery, radiation, and emergency. At present, in China's medical system, the boundaries of disciplines are clear, so interdisciplinary cooperation in the hospital is very difficult.

So how can we shorten the DTN time?

According to Liu Jianmin, the prevention and control of stroke is a chain, which is a closed-loop management from prevention, first aid, secondary prevention, rehabilitation to first aid after onset. According to the prevention and control experience of developed countries such as the United States, primary prevention (disease control, lifestyle changes) takes 30 to 50 years. In the last 20 years, these countries have begun to focus on the construction of stroke centers and stroke networks. This work has greatly reduced the mortality and disability rate of stroke patients.

In the case of a mature treatment plan, how to enable more stroke patients to obtain timely and effective treatment, first of all, to promote the construction of stroke centers. The core of the construction of the Stroke Center is to break the boundaries of the department, take the patient as the center, manage the plan as a whole, realize the collaboration and integration between the departments, and strive for the treatment time for the patients every minute.

It is reported that stroke is the only disease in a country that specializes in setting up a special disease prevention and treatment engineering committee. The main task of the "CEREC" is to carry out the construction of stroke centers nationwide. There are two cores: multidisciplinary collaboration and stroke network construction, promoting the information construction of the stroke center database, and continuing to promote the construction of regionalized stroke information network platform.

In an ideal stroke center, not only the first consultation, blood examination, imaging examination, internal medicine, endovascular treatment, multidisciplinary consultation, surgery, etc., all through the construction of the "green channel", but also through the hospital Pre-first aid and post-hospital management truly form a closed loop of coverage that covers the “full life cycle”.

Namely: from health management and disease warning, pre-hospital emergency, in-hospital green channel, diagnosis and treatment, neurological intensive care to stroke rehabilitation and secondary prevention, personnel, equipment, and data must be connected in real time, through intelligence Interconnection provides patients with a “seamless connection” to gain time, achieve more accurate diagnosis, better postoperative and rehabilitation management.

Professor Zhong Haizhong, Dean of Changhai Hospital, said: "As early as 2013, Changhai Hospital has transferred more than 60 doctors from the 12 departments of the hospital, scientifically reorganized, and mixed more than 60 doctors including neurosurgery, imaging, and vascular surgery. The establishment of a completely independent and interdisciplinary 'Cerebrovascular Disease Center'. By breaking the barriers between departments, the 'one-stop' stroke first-aid procedure was adopted. By 2017, we have achieved a DTN time of 20 minutes."

The Arterial Network has learned that the multidisciplinary integration of the Changhai Hospital Stroke Center is the number one project, so the attention and leadership of the Dean is also the key.

"We have used the management and technical means to get back the hospital's treatment time, but how can the patient waste time before the hospital?" Liu Jianmin said that the construction of the stroke network is the second most important link. In response, Changhai Hospital took the lead and established the Stroke First Aid Alliance in Yangpu District to form a network of all medical institutions in the region. Each of these medical institutions will be trained with the goal of getting any one of the stroke patients to any hospital without delay. Conditional institutions implement treatment, and unconditional institutions quickly refer to the “60-minute stroke gold treatment circle” covering northeastern Shanghai.

It is reported that after the establishment of the specialist alliance, Changhai Hospital also organized doctors in community hospitals near Yangpu District to supervise and guide them to conduct screening of high-risk populations in the whole community. After expanding from the point to the whole district and the whole city, Changhai Hospital also hopes to copy the model to the whole country.

"Now I am most proud of that 24 hours a day, any stroke patient arrives at the emergency room of Changhai Hospital, and enjoys the 'VVIP service' to get the most standardized treatment at the fastest speed." Liu Jianmin said.

According to an expert from Changhai Hospital, the difference between the foreign and domestic stroke patterns is not in the hospital, but in the pre-hospital first aid. The first-aid in foreign countries is relatively mature, and the hospital's rating system and treatment capacity are very clear. Whether it can be used for thrombectomy or thrombolysis, hospitals of different levels have clear responsibility regulations. These two factors ensure that any patient who has been diagnosed as a stroke on a 120 ambulance can be transported to a hospital that is capable of treatment. The connection between the 120 emergency system and the hospital has yet to be improved in China.

In order to solve this problem, Changhai Hospital set up a pre-hospital emergency school under the Shanghai Stroke Association. The school group is headed by the director of Shanghai 120 Emergency Center, and the doctor of Changhai Hospital is the deputy leader. The two sides have established a concrete and feasible implementation plan through coordination.

At present, the two sides have initially finalized the quality control standards for Shanghai 120 stroke diagnosis and treatment.

In addition to making changes in management and processes, Changhai Hospital also established a strategic cooperation with Philips (China) Investment Co., Ltd. in 2017, hoping to use the power of technology to minimize DTN time.

It is understood that Philips has a comprehensive solution covering the whole process of “health care” in the heart and cerebrovascular fields, including: Stroke multidisciplinary collaboration platform, accurate stroke assessment and early screening for high-risk groups, endovascular safety treatment and surgery, and critical information management. , Stroke big data management, post-hospital intelligent rehabilitation, etc., to help the medical system to achieve the "early" goals in the diagnosis and treatment of stroke diseases - early diagnosis, early treatment, early prevention of recurrence and early recovery.

Mr. He Guowei, CEO of Philips Greater China, said: “ Medical technology can only create greater value for doctors and patients if it is closely integrated into the actual clinical situation of China's medical system. Philips is committed to including hospitals, professional associations, scientific research institutions, The “local ecosystems”, such as universities, industry leaders, and local innovative companies, work together to bring innovations from the global platform to China more quickly and more closely, and to develop interconnections for the needs of 'stroke centers' at all levels. Technology-driven, big data and artificial intelligence-driven integrated stroke-specific disease solutions help Chinese healthcare systems improve the prevention and treatment of stroke diseases."

In 2018, the two sides further deepened the co-creation relationship and committed to creating a “full-course care solution for stroke diseases” in the real clinical situation in China through long-term close cooperation, with emphasis on Zhihui Health Platform, Pre-hospital First Aid and Green channel construction, post-hospital management and stroke rehabilitation have promoted Changhai Hospital to build a world-leading cerebrovascular disease center in the construction of stroke center, and promote Changhai model and experience to stroke centers at all levels to promote China. The overall level of prevention and treatment of stroke diseases has increased.

According to the World Health Organization survey, China's stroke incidence ranks first in the world, twice as high as in the United States. The results of the third national death survey in China indicate that stroke has risen to be the first cause of death in China and the first cause of adult disability. Monitoring results in the past two decades show that the number of deaths in stroke is more than 2 million, with an annual growth rate of 8.7%. In addition to high mortality, stroke also has the characteristics of high disability and high recurrence rate, which seriously threatens the quality of life and healthy life of the people.

The Media Awareness Day of the “Drug Diseases Full Care” held at the Clinical Neuromedicine Center of Changhai Hospital aims to actively respond to the six main goals highlighted in the “World Stroke Day” Declaration through the power of media propaganda, namely: fully mobilizing all walks of life Strength to prevent stroke, combine prevention of stroke with prevention of cardiovascular disease, cognitive impairment; establish an interdisciplinary stroke medical team; translate knowledge into action; develop new research methods; educate the public to participate actively; establish global cooperation.

During the interview, Liu Jianmin repeatedly emphasized the importance of mission. “To do an operation, the doctor saved a patient. But if you do a mission, there may be 300 families who understand the importance of stroke prevention. So in the future, I think that mission is more important than treatment!"

The preaching of the young and middle-aged people is a difficult task, because this group of people has little time to accept stroke education because of their busy work. Therefore, the mission model of Changhai Hospital is to grasp the two ends and start from the old one. On the one hand, Changhai Hospital cooperated with the Shanghai Municipal Education Commission to use the school to educate the children in the growing period. On the other hand, Changhai Hospital launched a publicity campaign for the elderly through the community.

Liu Jianmin believes that the way of missionary education is diverse and multi-layered. In addition to the hospital's own efforts, the media should also be the core force of stroke missions. At the same time, large companies like Philips should also contribute to missions, driven by a sense of social responsibility.

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