Nurse-Coordinated and Guideline-Driven Care in Acute Ischemic Stroke: A Prospective Study With Retrospective Propensity-Score Matched Controls.
Guili Guo, Lan Gao, Jie Zhao and 1 others
PMID 42563528WHAT IT FOUND
In acute ischemic stroke patients receiving thrombolysis, nurse-coordinated guideline-driven care was associated with more patients showing early neurological improvement at 24 hours (57.1% vs 42.0%) compared with routine care.
Door-to-needle time, symptomatic brain bleeding, and infection were also lower.
Key findings
01At 24 hours after thrombolysis, early neurological improvement occurred in 57.1% of patients receiving nurse-coordinated guideline-driven care and 42.0% receiving routine care, with a rate ratio of 1.361.
02Mean door-to-needle time was 51.43 minutes in the nurse-coordinated cohort and 80.23 minutes in the matched routine-care cohort.
03Symptomatic intracranial haemorrhage within 7 days was significantly less frequent in the nurse-coordinated cohort, with a rate ratio of 0.421.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The control patients were reviewed from records rather than randomly assigned, so differences other than nurse coordination may explain the results. The study was done at one centre, so it may not apply to other hospitals or patient groups. Propensity matching balanced measured baseline characteristics, but it cannot remove unmeasured confounding. The nurse-coordinated group and control group were treated in different time periods, so changes in protocols, staff experience, or general care may have affected outcomes. Some initially enrolled prospective patients were lost to follow-up.
Declared interests
The study was funded by the Beijing Municipal Administration of Hospital Incubating Program (PG2022016).
The easy way to misread this
Do not conclude that nurse coordination alone caused the better outcomes. The intervention bundled advanced nurse coordination with guideline training, standardised order sets, frequent monitoring, and multidisciplinary activation, and the control group was retrospective and from a different time period, so neither the single nursing component nor causality can be isolated.