Effect of Workflow Improvements in Endovascular Stroke Treatment

Background and Purpose— Rapid initiation of endovascular stroke treatment is associated with better clinical outcome. The effect of specific improvements is not well known. We performed a systematic review and meta-analysis on the effectiveness of specific workflow improvements on time to treatment and outcome. Methods— A random-effects meta-analysis was used to evaluate the difference in mean time to treatment between intervention group and control group. Secondary outcomes included good functional outcome at 90 days (modified Rankin Scale score 0–2). Results— Fifty-one studies (3 randomized controlled trials, 13 prepost intervention studies, and 35 observational studies) with in total 8467 patients were included. Most frequently reported workflow intervention types concerned anesthetic management (n=26), in-hospital patient transfer management (n=14), and prehospital management (n=11). Patients in the intervention group had shorter time to treatment intervals (weighted mean difference, 26 minutes; 95% C...