Gestão em rede no atendimento ao acidente vascular cerebral: revisão integrativa de literatura

Brandão, Paloma de Castro; Lanzoni, Gabriela Marcellino de Melo; Pinto, Isabela Cardoso de Matos

doi:10.1590/S0104-12902023220793pt

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Revisão crítica de literatura • Saude soc. 32 (Suppl 2) • 2023 • https://doi.org/10.1590/S0104-12902023220793pt copiar

Gestão em rede no atendimento ao acidente vascular cerebral: revisão integrativa de literatura

Network management in acute stroke care: integrative literature review

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

O objetivo deste artigo é analisar as publicações científicas sobre a gestão em rede no atendimento ao paciente com acidente vascular cerebral agudo, considerando as tecnologias implantadas e suas consequências para a atuação da equipe. Foi feita uma revisão integrativa de literatura, operacionalizada nas seguintes bases de dados: PubMed/Medline, Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde e no Índice Bibliográfico Espanhol de Ciências da Saúde, de 2008 a 2022, com sintaxe de palavras-chave para cada base. A análise dos dados foi realizada por meio da similaridade de conteúdo, sendo posteriormente elaboradas as categorias. Foram selecionados 46 artigos para análise, um nacional e os demais publicados em periódicos estrangeiros. Ressaltam-se as tecnologias empregadas para ampliar a gestão em rede na atenção ao paciente com Acidente Vascular Cerebral isquêmico agudo, como a conexão entre serviços por fluxos e protocolos, por meio da regionalização, da telemedicina e de plataforma de smartphone, com a ampliação das funções da equipe intervencionista móvel, ou por elementos integradores, como a pré-notificação hospitalar.

Palavras-chave:
Acidente Vascular Cerebral; Enfermagem em Emergência; Serviços Médicos de Emergência; Integralidade em Saúde; Transferência de Pacientes

País	Tecnologias implantadas para a gestão em Rede	Consequências para os atendimentos
EUA, Espanha, Canadá, Itália, Portugal, Inglaterra, República Tcheca, China, Austrália e Brasil.	Fluxos e protocolos	A instituição de fluxos e protocolos proporcionou aumento na taxa de administração de trombólise (Bergrath et al., 2012BERGRATH, S. et al. Feasibility of prehospital teleconsultation in acute stroke: a pilot study in clinical routine. PLoS ONE, San Francisco, v. 7, n. 5, 2012. DOI: 10.1371/journal.pone.0036796 https://doi.org/10.1371/journal.pone.003... ; Clua-Espuny et al., 2012; Demaerschalk; Bobrow; Paulsen, 2008DEMAERSCHALK, B. M.; BOBROW, B. J.; PAULSEN, M. Development of a metropolitan matrix of primary stroke centers. Stroke, Washington, DC, v. 39, n. 4, p. 1246-1253, 2008. DOI: 10.1161/STROKEAHA.107.500678 https://doi.org/10.1161/STROKEAHA.107.50... ; Gladstone et al., 2009GLADSTONE, D. J. et al. A citywide prehospital protocol increases access to stroke thrombolysis in Toronto. Stroke, Washington, DC, v. 40, n. 12, p. 3841-3844, 2009. DOI: 10.1161/STROKEAHA.108.540377 https://doi.org/10.1161/STROKEAHA.108.54... ; Joyce; Amlani, 2009JOYCE, A.; AMLANI, S. Integrated stroke care across a province: is it possible? Healthcare Quarterly, Washington, DC, v. 13, p. 80-84, 2009. DOI: 10.12927/hcq.2009.21103 https://doi.org/10.12927/hcq.2009.21103... ; Kapral et al., 2013KAPRAL, M. K. et al. Effect of a provincial system of stroke care delivery on stroke care and outcomes. Canadian Medical Association Journal, Washington, DC, v. 185, n. 10, 2013. DOI: 10.1503/cmaj.121418 https://doi.org/10.1503/cmaj.121418... ; O’Brien et al., 2012O’BRIEN, W. et al. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of central coast stroke services implementation of a pre-hospital notification system for expedient management of acute stroke. Journal of Clinical Neuroscience, Washington, DC, v. 19, n. 2, p. 241-245, 2012. DOI: 10.1016/j.jocn.2011.06.009 https://doi.org/10.1016/j.jocn.2011.06.0... ; Parra et al., 2012PARRA, C. et al. Development, implementation, and evaluation of a telemedicine service for the treatment of acute stroke patients: telestroke. Interactive Journal of Medical Research, Washington, DC, v. 1, n. 2, 2012. DOI: 10.2196/ijmr.2163 https://doi.org/10.2196/ijmr.2163... ; Pedragosa et al., 2009PEDRAGOSA, A. et al. Impact of a telemedicine system on acute stroke care in a community hospital. Journal of Telemedicine and Telecare, Washington, DC, v. 15, n. 5, p. 260-263, 2009. DOI: 10.1258/jtt.2009.090102 https://doi.org/10.1258/jtt.2009.090102... ; Herrero, 2008HERRERO, P. D. N. Early access to stroke referral centres offers clinical benefits: the stroke code. Revista de Neurología, Barcelona, v. 47, n. 8, p. 427-433, 2008.; Soares-Oliveira; Araújo, 2014SOARES-OLIVEIRA, M.; ARAÚJO, F. Implementation of a regional system for the emergency care of acute ischemic stroke: Initial results. Revista Portuguesa de Cardiologia, Amsterdam, v. 33, n. 6, p. 329-335, 2014. DOI: 10.1016/j.repc.2013.11.004 https://doi.org/10.1016/j.repc.2013.11.0... ; Vidale et al., 2012VIDALE, S. et al. Stroke management in Northern Lombardy: organization of an emergency-urgency network and development of a connection between prehospital and in-hospital settings. International Journal of Stroke, Washington, DC, v. 7, n. 6, p. 527-533, 2012. DOI: 10.1111/j.1747-4949.2012.00792.x https://doi.org/10.1111/j.1747-4949.2012... ); aumento na realização de trombectomia (Kapral et al., 2013KAPRAL, M. K. et al. Effect of a provincial system of stroke care delivery on stroke care and outcomes. Canadian Medical Association Journal, Washington, DC, v. 185, n. 10, 2013. DOI: 10.1503/cmaj.121418 https://doi.org/10.1503/cmaj.121418... ; Meretoja et al., 2013MERETOJA, A. et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology, Washington, DC, v. 81, n. 12, p. 1071-1076, 2013. DOI: 10.1212/WNL.0b013e3182a4a4d2 https://doi.org/10.1212/WNL.0b013e3182a4... ), redução dos atrasos de forma geral (Lamonte et al., 2009LAMONTE, M. P. et al. A regional system of stroke care provides thrombolytic outcomes comparable with the NINDS stroke trial. Annals of Emergency Medicine, Washington, DC, v. 54, n. 3, p. 319-327, 2009. DOI: 10.1016/j.annemergmed.2008.09.022 https://doi.org/10.1016/j.annemergmed.20... ), redução do tempo porta-agulha (Bergrath et al., 2012BERGRATH, S. et al. Feasibility of prehospital teleconsultation in acute stroke: a pilot study in clinical routine. PLoS ONE, San Francisco, v. 7, n. 5, 2012. DOI: 10.1371/journal.pone.0036796 https://doi.org/10.1371/journal.pone.003... ; Joyce; Amlani, 2009JOYCE, A.; AMLANI, S. Integrated stroke care across a province: is it possible? Healthcare Quarterly, Washington, DC, v. 13, p. 80-84, 2009. DOI: 10.12927/hcq.2009.21103 https://doi.org/10.12927/hcq.2009.21103... ; Meretoja et al., 2013MERETOJA, A. et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology, Washington, DC, v. 81, n. 12, p. 1071-1076, 2013. DOI: 10.1212/WNL.0b013e3182a4a4d2 https://doi.org/10.1212/WNL.0b013e3182a4... ; O’Brien et al., 2012O’BRIEN, W. et al. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of central coast stroke services implementation of a pre-hospital notification system for expedient management of acute stroke. Journal of Clinical Neuroscience, Washington, DC, v. 19, n. 2, p. 241-245, 2012. DOI: 10.1016/j.jocn.2011.06.009 https://doi.org/10.1016/j.jocn.2011.06.0... ; Herrero, 2008HERRERO, P. D. N. Early access to stroke referral centres offers clinical benefits: the stroke code. Revista de Neurología, Barcelona, v. 47, n. 8, p. 427-433, 2008.; Vidale et al., 2012VIDALE, S. et al. Stroke management in Northern Lombardy: organization of an emergency-urgency network and development of a connection between prehospital and in-hospital settings. International Journal of Stroke, Washington, DC, v. 7, n. 6, p. 527-533, 2012. DOI: 10.1111/j.1747-4949.2012.00792.x https://doi.org/10.1111/j.1747-4949.2012... ), redução na taxa de transformação hemorrágica (Joyce; Amlani, 2009JOYCE, A.; AMLANI, S. Integrated stroke care across a province: is it possible? Healthcare Quarterly, Washington, DC, v. 13, p. 80-84, 2009. DOI: 10.12927/hcq.2009.21103 https://doi.org/10.12927/hcq.2009.21103... ; Herrero, 2008HERRERO, P. D. N. Early access to stroke referral centres offers clinical benefits: the stroke code. Revista de Neurología, Barcelona, v. 47, n. 8, p. 427-433, 2008.), redução da mortalidade pela doença (O’Brien et al., 2012O’BRIEN, W. et al. FASTER (Face, Arm, Speech, Time, Emergency Response): experience of central coast stroke services implementation of a pre-hospital notification system for expedient management of acute stroke. Journal of Clinical Neuroscience, Washington, DC, v. 19, n. 2, p. 241-245, 2012. DOI: 10.1016/j.jocn.2011.06.009 https://doi.org/10.1016/j.jocn.2011.06.0... ). Houve melhoria em todas as etapas do atendimento (Lamonte et al., 2009LAMONTE, M. P. et al. A regional system of stroke care provides thrombolytic outcomes comparable with the NINDS stroke trial. Annals of Emergency Medicine, Washington, DC, v. 54, n. 3, p. 319-327, 2009. DOI: 10.1016/j.annemergmed.2008.09.022 https://doi.org/10.1016/j.annemergmed.20... ; Pedragosa et al., 2009PEDRAGOSA, A. et al. Impact of a telemedicine system on acute stroke care in a community hospital. Journal of Telemedicine and Telecare, Washington, DC, v. 15, n. 5, p. 260-263, 2009. DOI: 10.1258/jtt.2009.090102 https://doi.org/10.1258/jtt.2009.090102... ; Williams et al., 2009WILLIAMS, I. et al. An emergency medical services toolkit for improving systems of care for stroke in North Carolina. Preventing Chronic Disease, Washington, DC, v. 6, n. 2, 2009.), desde o reconhecimento dos sinais e sintomas até a recuperação e reabilitação, com maior acesso a centros de AVC (Bergrath et al., 2012BERGRATH, S. et al. Feasibility of prehospital teleconsultation in acute stroke: a pilot study in clinical routine. PLoS ONE, San Francisco, v. 7, n. 5, 2012. DOI: 10.1371/journal.pone.0036796 https://doi.org/10.1371/journal.pone.003... ; Parra et al., 2012PARRA, C. et al. Development, implementation, and evaluation of a telemedicine service for the treatment of acute stroke patients: telestroke. Interactive Journal of Medical Research, Washington, DC, v. 1, n. 2, 2012. DOI: 10.2196/ijmr.2163 https://doi.org/10.2196/ijmr.2163... ). Redução do tempo de atendimento pré-hospitalar (Bergrath et al., 2012BERGRATH, S. et al. Feasibility of prehospital teleconsultation in acute stroke: a pilot study in clinical routine. PLoS ONE, San Francisco, v. 7, n. 5, 2012. DOI: 10.1371/journal.pone.0036796 https://doi.org/10.1371/journal.pone.003... ; Parra et al., 2012PARRA, C. et al. Development, implementation, and evaluation of a telemedicine service for the treatment of acute stroke patients: telestroke. Interactive Journal of Medical Research, Washington, DC, v. 1, n. 2, 2012. DOI: 10.2196/ijmr.2163 https://doi.org/10.2196/ijmr.2163... ) e do tempo de transporte (Clua-Espuny et al., 2012CLUA-ESPUNY, J. L. et al. La atención sanitaria del ictus en el área Terres de l’Ebre desde la implantación del Código Ictus: Estudio Ebrictus. Medicina Clínica, Amsterdam, v. 138, n. 14, p. 609-611, 2012. DOI: 10.1016/j.medcli.2011.10.004 https://doi.org/10.1016/j.medcli.2011.10... ; Vidale et al., 2012VIDALE, S. et al. Stroke management in Northern Lombardy: organization of an emergency-urgency network and development of a connection between prehospital and in-hospital settings. International Journal of Stroke, Washington, DC, v. 7, n. 6, p. 527-533, 2012. DOI: 10.1111/j.1747-4949.2012.00792.x https://doi.org/10.1111/j.1747-4949.2012... ).
	Fluxos e protocolos	Houve melhoria no gerenciamento dos pacientes antes de sua chegada ao hospital (Brandão et al., 2022BRANDÃO, P. C.; LANZONI, G. M. M.; PINTO, I. C. M. Network professional interaction in the care of patients with stroke. Revista Brasileira de Enfermagem, Brasília, DF, v. 75, n. 5, 2022. DOI: 10.1590/0034-7167-2021-0533 https://doi.org/10.1590/0034-7167-2021-0... ; Gladstone et al., 2009GLADSTONE, D. J. et al. A citywide prehospital protocol increases access to stroke thrombolysis in Toronto. Stroke, Washington, DC, v. 40, n. 12, p. 3841-3844, 2009. DOI: 10.1161/STROKEAHA.108.540377 https://doi.org/10.1161/STROKEAHA.108.54... ), segurança e eficácia (Joyce; Amlani, 2009JOYCE, A.; AMLANI, S. Integrated stroke care across a province: is it possible? Healthcare Quarterly, Washington, DC, v. 13, p. 80-84, 2009. DOI: 10.12927/hcq.2009.21103 https://doi.org/10.12927/hcq.2009.21103... ), agilidade e sincronia no fluxo de informações entre serviços (Singh et al., 2014SINGH, R. et al. Assimilation of web-based urgent stroke evaluation: a qualitative study of two networks. JMIR Medical Informatics, Washington, DC, v. 2, n. 1, 2014. DOI: 10.2196/medinform.3028 https://doi.org/10.2196/medinform.3028... ; Brandão, 2022BRANDÃO, P. C.; LANZONI, G. M. M.; PINTO, I. C. M. Network professional interaction in the care of patients with stroke. Revista Brasileira de Enfermagem, Brasília, DF, v. 75, n. 5, 2022. DOI: 10.1590/0034-7167-2021-0533 https://doi.org/10.1590/0034-7167-2021-0... ), otimização do tempo médio despendido no departamento de emergência (Clua-Espuny et al., 2012CLUA-ESPUNY, J. L. et al. La atención sanitaria del ictus en el área Terres de l’Ebre desde la implantación del Código Ictus: Estudio Ebrictus. Medicina Clínica, Amsterdam, v. 138, n. 14, p. 609-611, 2012. DOI: 10.1016/j.medcli.2011.10.004 https://doi.org/10.1016/j.medcli.2011.10... ; Meretoja et al., 2013MERETOJA, A. et al. Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months. Neurology, Washington, DC, v. 81, n. 12, p. 1071-1076, 2013. DOI: 10.1212/WNL.0b013e3182a4a4d2 https://doi.org/10.1212/WNL.0b013e3182a4... ) e redução no tempo que os paramédicos gastam em um centro regional de AVC (Clua-Espuny et al., 2012CLUA-ESPUNY, J. L. et al. La atención sanitaria del ictus en el área Terres de l’Ebre desde la implantación del Código Ictus: Estudio Ebrictus. Medicina Clínica, Amsterdam, v. 138, n. 14, p. 609-611, 2012. DOI: 10.1016/j.medcli.2011.10.004 https://doi.org/10.1016/j.medcli.2011.10... ).
EUA, Espanha, Canadá, Alemanha e Inglaterra.	Telemedicina	A telemedicina proporcionou aumento do número de pacientes avaliados com urgência por um neurologista (Sanossian et al., 2015SANOSSIAN, N. et al. Routing ambulances to designated centers increases access to stroke center care and enrollment in prehospital research. Stroke, Washington, DC, v. 46, n. 10, p. 2886-2890, 2015.) e aumento da taxa de administração de trombólise (Commiskey et al., 2017COMMISKEY, P. et al. Description of a novel telemedicine-enabled comprehensive system of care: drip and ship plus drip and keep within a system of stroke care delivery. Journal of Telemedicine and Telecare, Washington, DC, v. 23, n. 3, p. 428-436, 2017. DOI: 10.1177/1357633x16637967 https://doi.org/10.1177/1357633x16637967... ; Hsieh et al., 2016HSIEH, M.-J. et al. Effect of prehospital notification on acute stroke care: a multicenter study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Washington, DC, v. 24, n. 1, p. 57, 2016. DOI: 10.1186/s13049-016-0251-2 https://doi.org/10.1186/s13049-016-0251-... ; Sanossian et al., 2015SANOSSIAN, N. et al. Routing ambulances to designated centers increases access to stroke center care and enrollment in prehospital research. Stroke, Washington, DC, v. 46, n. 10, p. 2886-2890, 2015.; Tan et al., 2017TAN, B. et al. Improvement in door-to-needle times in patients with acute ischaemic stroke via the application of a simple stroke activation protocol. Journal of the Neurological Sciences, Washington, DC, v. 381, p. 1106-1107, 2017. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.005 https://doi.org/10.1016/j.jstrokecerebro... ; Evans et al., 2022EVANS, N. R. et al. Hyperacute stroke thrombolysis via telemedicine: a multicentre study of performance, safety and clinical efficacy. BMJ Open, London, v. 12, n. 1, 2022. DOI: 10.1136/bmjopen-2021-057372 https://doi.org/10.1136/bmjopen-2021-057... ; Adcock et al., 2020ADCOCK, A. K. et al. Expanding acute stroke care in rural America: a model for statewide success. Telemedicine Journal and e-Health, Washington, DC, v. 26, n. 7, p. 865-871, 2019. DOI: 10.1089/tmj.2019.0087 https://doi.org/10.1089/tmj.2019.0087... ) de forma segura e eficaz (Sheppard et al., 2015SHEPPARD, J. P. et al. The association between prehospital care and in-hospital treatment decisions in acute stroke: a cohort study. Emergency Medicine Journal, Washington, DC, v. 32, n. 2, p. 93-99, 2015. DOI: 10.1136/emermed-2013-203026 https://doi.org/10.1136/emermed-2013-203... ; Tan et al., 2017TAN, B. et al. Improvement in door-to-needle times in patients with acute ischaemic stroke via the application of a simple stroke activation protocol. Journal of the Neurological Sciences, Washington, DC, v. 381, p. 1106-1107, 2017. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.005 https://doi.org/10.1016/j.jstrokecerebro... ; Uscher-Pines et al., 2020USCHER-PINES, L. et al. What drives greater assimilation of telestroke in emergency departments? Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 29, n. 12, 2020. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105310 https://doi.org/10.1016/j.jstrokecerebro... ). Segurança e confiabilidade no suporte à tomada de decisões de trombólise (Dimitrov et al., 2015DIMITROV, N. et al. Variability in criteria for emergency medical services routing of acute stroke patients to designated stroke center hospitals. Western Journal of Emergency Medicine, Washington, DC, v. 16, n. 5, p. 743-746, 2015. DOI: 10.5811/westjem.2015.7.26179 https://doi.org/10.5811/westjem.2015.7.2... ; Uscher-Pines et al., 2020USCHER-PINES, L. et al. What drives greater assimilation of telestroke in emergency departments? Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 29, n. 12, 2020. DOI: 10.1016/j.jstrokecerebrovasdis.2020.105310 https://doi.org/10.1016/j.jstrokecerebro... ), melhorando a qualidade e agilidade no diagnóstico (Kodankandath et al., 2017KODANKANDATH, T. V. et al. Improving transfer times for acute ischemic stroke patients to a comprehensive stroke center. Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 26, n. 1, p. 192-195, 2017. DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.008 https://doi.org/10.1016/j.jstrokecerebro... ; Evans et al., 2022EVANS, N. R. et al. Hyperacute stroke thrombolysis via telemedicine: a multicentre study of performance, safety and clinical efficacy. BMJ Open, London, v. 12, n. 1, 2022. DOI: 10.1136/bmjopen-2021-057372 https://doi.org/10.1136/bmjopen-2021-057... ), detectando sintomas pouco perceptíveis (Dimitrov et al., 2015DIMITROV, N. et al. Variability in criteria for emergency medical services routing of acute stroke patients to designated stroke center hospitals. Western Journal of Emergency Medicine, Washington, DC, v. 16, n. 5, p. 743-746, 2015. DOI: 10.5811/westjem.2015.7.26179 https://doi.org/10.5811/westjem.2015.7.2... ) obtendo clareza na contraindicação da trombólise (Dimitrov et al., 2015DIMITROV, N. et al. Variability in criteria for emergency medical services routing of acute stroke patients to designated stroke center hospitals. Western Journal of Emergency Medicine, Washington, DC, v. 16, n. 5, p. 743-746, 2015. DOI: 10.5811/westjem.2015.7.26179 https://doi.org/10.5811/westjem.2015.7.2... ). Houve maior acesso à tomografia (Hsieh et al., 2016HSIEH, M.-J. et al. Effect of prehospital notification on acute stroke care: a multicenter study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Washington, DC, v. 24, n. 1, p. 57, 2016. DOI: 10.1186/s13049-016-0251-2 https://doi.org/10.1186/s13049-016-0251-... ) e à terapia antitrombótica, redução dos custos (Klingner et al., 2018KLINGNER, C. M. et al. Transfer of patients in a telestroke network: what are the relevant factors for making this decision? Telemedicine and e-Health, Washington, DC, v. 24, n. 2, p. 116-120, 2018. DOI: 10.1089/tmj.2017.0087 https://doi.org/10.1089/tmj.2017.0087... ; Rodríguez-Castro et al., 2018RODRÍGUEZ-CASTRO, E. et al. Plan de asistencia al ictus en Galicia: telemedicina para un tratamiento hospitalario multidisciplinar, precoz y universal del ictus agudo. Emergencias, St. Vicenç dels Horts, p. 54-61, 2018.; Sanossian et al., 2015SANOSSIAN, N. et al. Routing ambulances to designated centers increases access to stroke center care and enrollment in prehospital research. Stroke, Washington, DC, v. 46, n. 10, p. 2886-2890, 2015.; Tan et al., 2017TAN, B. et al. Improvement in door-to-needle times in patients with acute ischaemic stroke via the application of a simple stroke activation protocol. Journal of the Neurological Sciences, Washington, DC, v. 381, p. 1106-1107, 2017. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.005 https://doi.org/10.1016/j.jstrokecerebro... ) e das transferências inter-hospitalares (Klingner et al., 2018KLINGNER, C. M. et al. Transfer of patients in a telestroke network: what are the relevant factors for making this decision? Telemedicine and e-Health, Washington, DC, v. 24, n. 2, p. 116-120, 2018. DOI: 10.1089/tmj.2017.0087 https://doi.org/10.1089/tmj.2017.0087... ; Rodríguez-Castro et al., 2018RODRÍGUEZ-CASTRO, E. et al. Plan de asistencia al ictus en Galicia: telemedicina para un tratamiento hospitalario multidisciplinar, precoz y universal del ictus agudo. Emergencias, St. Vicenç dels Horts, p. 54-61, 2018.; Sanossian et al., 2015SANOSSIAN, N. et al. Routing ambulances to designated centers increases access to stroke center care and enrollment in prehospital research. Stroke, Washington, DC, v. 46, n. 10, p. 2886-2890, 2015.; Tan et al., 2017TAN, B. et al. Improvement in door-to-needle times in patients with acute ischaemic stroke via the application of a simple stroke activation protocol. Journal of the Neurological Sciences, Washington, DC, v. 381, p. 1106-1107, 2017. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.005 https://doi.org/10.1016/j.jstrokecerebro... ; Adcock et al., 2020ADCOCK, A. K. et al. Expanding acute stroke care in rural America: a model for statewide success. Telemedicine Journal and e-Health, Washington, DC, v. 26, n. 7, p. 865-871, 2019. DOI: 10.1089/tmj.2019.0087 https://doi.org/10.1089/tmj.2019.0087... ). Houve eficiência da pré-notificação hospitalar (Kendall; Dutta; Brown, 2015KENDALL, J.; DUTTA, D.; BROWN, E. Reducing delay to stroke thrombolysis: lessons learnt from the Stroke 90 Project. Emergency Medicine Journal, Washington, DC, v. 32, n. 2, p. 100-104, 2015. DOI: 10.1136/emermed-2013-202993 https://doi.org/10.1136/emermed-2013-202... ), maio acesso a centros de AVC (Hsieh et al., 2016HSIEH, M.-J. et al. Effect of prehospital notification on acute stroke care: a multicenter study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Washington, DC, v. 24, n. 1, p. 57, 2016. DOI: 10.1186/s13049-016-0251-2 https://doi.org/10.1186/s13049-016-0251-... ) e redução da mortalidade (Hsieh et al., 2016HSIEH, M.-J. et al. Effect of prehospital notification on acute stroke care: a multicenter study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Washington, DC, v. 24, n. 1, p. 57, 2016. DOI: 10.1186/s13049-016-0251-2 https://doi.org/10.1186/s13049-016-0251-... ; Kodankandath et al., 2017KODANKANDATH, T. V. et al. Improving transfer times for acute ischemic stroke patients to a comprehensive stroke center. Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 26, n. 1, p. 192-195, 2017. DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.008 https://doi.org/10.1016/j.jstrokecerebro... ).
		Houve aumento da taxa da população a 30 minutos de um centro de AVC (Swartz et al., 2017SWARTZ, R. H. et al. A system-based intervention to improve access to hyperacute stroke care. Canadian Journal of Neurological Sciences, Washington, DC, v. 44, n. 5, p. 475-482, 2017. DOI: 10.1017/cjn.2017.40 https://doi.org/10.1017/cjn.2017.40... ), redução de internações em centros que costumam ter uma carga excessiva de trabalho (Tan et al., 2017TAN, B. et al. Improvement in door-to-needle times in patients with acute ischaemic stroke via the application of a simple stroke activation protocol. Journal of the Neurological Sciences, Washington, DC, v. 381, p. 1106-1107, 2017. doi: 10.1016/j.jstrokecerebrovasdis.2018.01.005 https://doi.org/10.1016/j.jstrokecerebro... ), mantendo os pacientes mais próximos de casa (Jewett et al., 2017JEWETT, L. et al. Use of geospatial modeling to evaluate the impact of telestroke on access to stroke thrombolysis in Ontario. Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 26, n. 7, p. 1400-1406, 2017. DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.023 https://doi.org/10.1016/j.jstrokecerebro... ) e melhorando a qualidade de vida dos que vivem em área rural (Klingner et al., 2018KLINGNER, C. M. et al. Transfer of patients in a telestroke network: what are the relevant factors for making this decision? Telemedicine and e-Health, Washington, DC, v. 24, n. 2, p. 116-120, 2018. DOI: 10.1089/tmj.2017.0087 https://doi.org/10.1089/tmj.2017.0087... ).
		Potencialização da colaboração entre níveis de saúde e entre profissionais (Jewett et al., 2017JEWETT, L. et al. Use of geospatial modeling to evaluate the impact of telestroke on access to stroke thrombolysis in Ontario. Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 26, n. 7, p. 1400-1406, 2017. DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.023 https://doi.org/10.1016/j.jstrokecerebro... ; Kodankandath et al., 2017KODANKANDATH, T. V. et al. Improving transfer times for acute ischemic stroke patients to a comprehensive stroke center. Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 26, n. 1, p. 192-195, 2017. DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.008 https://doi.org/10.1016/j.jstrokecerebro... ) e favorecimento da integração de capital humano, tecnologia e procedimentos, universalizando os cuidados de saúde (Kodankandath et al., 2017KODANKANDATH, T. V. et al. Improving transfer times for acute ischemic stroke patients to a comprehensive stroke center. Journal of Stroke and Cerebrovascular Diseases, Washington, DC, v. 26, n. 1, p. 192-195, 2017. DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.008 https://doi.org/10.1016/j.jstrokecerebro... ).
Canadá, Reino Unido, China, Austrália, Malásia, Alemanha e Irlanda.	Pré-notificação hospitalar	A pré-notificação hospitalar aumentou o acesso a centros de AVC (López-Cancio et al., 2018LÓPEZ-CANCIO, E. et al. Telestroke in Catalonia: increasing thrombolysis rate and avoiding interhospital transfers. Cerebrovascular Diseases, Washington, DC, v. 46, n. 1-2, p. 66-71, 2018. DOI: 10.1159/000492124 https://doi.org/10.1159/000492124... ; Whetten et al., 2018WHETTEN, J. et al. Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program. Journal of Medical Economics, Washington, DC, v. 21, n. 4, p. 398-405, 2018. DOI: 10.1080/13696998.2018.1426591 https://doi.org/10.1080/13696998.2018.14... ), proporcionando maior probabilidade em receber uma avaliação mais rápida na chegada ao hospital (Kansagra et al., 2018KANSAGRA, A. P. et al. Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke. Clinical Neurology and Neurosurgery, Washington, DC, v. 166, p. 71-75, 2018. DOI: 10.1016/j.clineuro.2018.01.026 https://doi.org/10.1016/j.clineuro.2018.... ). Houve redução do tempo porta-tomografia (Kansagra et al., 2018KANSAGRA, A. P. et al. Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke. Clinical Neurology and Neurosurgery, Washington, DC, v. 166, p. 71-75, 2018. DOI: 10.1016/j.clineuro.2018.01.026 https://doi.org/10.1016/j.clineuro.2018.... ; López-Cancio et al., 2018LÓPEZ-CANCIO, E. et al. Telestroke in Catalonia: increasing thrombolysis rate and avoiding interhospital transfers. Cerebrovascular Diseases, Washington, DC, v. 46, n. 1-2, p. 66-71, 2018. DOI: 10.1159/000492124 https://doi.org/10.1159/000492124... ; Polivka; Polivka; Rohan, 2018POLIVKA, J.; POLIVKA, J.; ROHAN, V. Predictive and individualized management of stroke: success story in Czech Republic. EPMA Journal, Washington, DC, v. 9, n. 4, p. 393-401, 2018. DOI: 10.1007/s13167-018-0150-x https://doi.org/10.1007/s13167-018-0150-... ), redução do tempo para acesso ao tratamento (López-Cancio et al., 2018LÓPEZ-CANCIO, E. et al. Telestroke in Catalonia: increasing thrombolysis rate and avoiding interhospital transfers. Cerebrovascular Diseases, Washington, DC, v. 46, n. 1-2, p. 66-71, 2018. DOI: 10.1159/000492124 https://doi.org/10.1159/000492124... ; Whetten et al., 2018WHETTEN, J. et al. Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program. Journal of Medical Economics, Washington, DC, v. 21, n. 4, p. 398-405, 2018. DOI: 10.1080/13696998.2018.1426591 https://doi.org/10.1080/13696998.2018.14... ; Pallesen et al., 2022PALLESEN, L. et al. Team prenotification reduces procedure times for patients with acute ischemic stroke due to large vessel occlusion who are transferred for endovascular therapy. Frontiers in Neurology, Washington, DC, v. 12, 2022. DOI: 10.3389/fneur.2021.787161 https://doi.org/10.3389/fneur.2021.78716... ; Gaynor et al., 2022GAYNOR, E. et al. Ambulance waiting and associated work flow improvement strategies: a pilot study to improve door-in-door-out time for thrombectomy patients in a primary stroke center. Journal of Neurointerventional Surgery, Washington, DC, v. 14, n. 6, p. 573-576, 2022. DOI: 10.1136/neurintsurg-2021-017653 https://doi.org/10.1136/neurintsurg-2021... ) e aumento na taxa de administração de trombólise (López-Cancio et al., 2018LÓPEZ-CANCIO, E. et al. Telestroke in Catalonia: increasing thrombolysis rate and avoiding interhospital transfers. Cerebrovascular Diseases, Washington, DC, v. 46, n. 1-2, p. 66-71, 2018. DOI: 10.1159/000492124 https://doi.org/10.1159/000492124... ; Polivka; Polivka; Rohan, 2018POLIVKA, J.; POLIVKA, J.; ROHAN, V. Predictive and individualized management of stroke: success story in Czech Republic. EPMA Journal, Washington, DC, v. 9, n. 4, p. 393-401, 2018. DOI: 10.1007/s13167-018-0150-x https://doi.org/10.1007/s13167-018-0150-... ). Com isso, houve consequente redução no uso de leitos no departamento de emergência (Whetten et al., 2018WHETTEN, J. et al. Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program. Journal of Medical Economics, Washington, DC, v. 21, n. 4, p. 398-405, 2018. DOI: 10.1080/13696998.2018.1426591 https://doi.org/10.1080/13696998.2018.14... ), melhor organização de várias atividades multidisciplinares (Seah et al., 2019SEAH, H. M. et al. Code Stroke Alert: concept and development of a novel open-source platform to streamline acute stroke management. Frontiers in Neurology, Washington, DC, v. 10, 2019. DOI: 10.3389/fneur.2019.00725 https://doi.org/10.3389/fneur.2019.00725... ) e melhoria na recuperação funcional dos pacientes (Pallesen et al., 2022PALLESEN, L. et al. Team prenotification reduces procedure times for patients with acute ischemic stroke due to large vessel occlusion who are transferred for endovascular therapy. Frontiers in Neurology, Washington, DC, v. 12, 2022. DOI: 10.3389/fneur.2021.787161 https://doi.org/10.3389/fneur.2021.78716... ).
China	Plataforma de Smartphone	A utilização de plataforma de smartphone levou à melhoria gerencial no atendimento de emergência ao paciente com AVC, desde o ambiente pré-hospitalar ao hospitalar, possibilitando a comunicação em tempo real e redução dos tempos de atendimento (Wu et al., 2021WU, Y. et al. Use of a smartphone platform to help with emergency management of acute ischemic stroke: observational study. JMIR mHealth and uHealth, Washington, DC, v. 9, n. 2, 2021. DOI: 10.2196/25488. https://doi.org/10.2196/25488... ).
EUA	Equipe de AVC intervencionista móvel	Equipes de AVC intervencionistas móveis que permanecem com o paciente no pronto socorro até análise de imagem são apontadas como uma nova abordagem para viabilidade, agilidade e eficiência na realização da terapia endovascular (Morey et al., 2020MOREY, J. R. et al. Mobile interventional stroke team model improves early outcomes in large vessel occlusion stroke: the NYC MIST trial. Stroke, Washington, DC, v. 51, n. 12, p. 3495-3503, 2020. DOI: 10.1161/STROKEAHA.120.030248 https://doi.org/10.1161/STROKEAHA.120.03... ; Glober et al., 2022GLOBER, N. et al. A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes. PLoS One, San Francisco, v. 17, n. 2, 2022. DOI: 10.1371/journal.pone.0264539 https://doi.org/10.1371/journal.pone.026... ). Esse protocolo substituiu o acionamento posterior de outra equipe para o transporte ao hospital que realizará o tratamento, resultando em menor tempo porta-recanalização (Morey et al., 2020MOREY, J. R. et al. Mobile interventional stroke team model improves early outcomes in large vessel occlusion stroke: the NYC MIST trial. Stroke, Washington, DC, v. 51, n. 12, p. 3495-3503, 2020. DOI: 10.1161/STROKEAHA.120.030248 https://doi.org/10.1161/STROKEAHA.120.03... ).
EUA	Regionalização	A regionalização do atendimento ao AVC levou a aumento na detecção de AVC por paramédico, maior número de transportes para centros primários de AVC e uso mais frequente de Alteplase intravenosa em centros de AVC (Govindarajan et al., 2019GOVINDARAJAN, P. et al. Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties. Prehospital Emergency Care, Washington, DC, v. 24, n. 4, p. 505-514, 2019. DOI: 10.1080/10903127.2019.1679303 https://doi.org/10.1080/10903127.2019.16... ).

Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. Av. dr. Arnaldo, 715, Prédio da Biblioteca, 2º andar sala 2, 01246-904 São Paulo - SP - Brasil, Tel./Fax: +55 11 3061-7880 - São Paulo - SP - Brazil
E-mail: saudesoc@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondência Paloma de Castro Brandão R. Basílio da Gama, 241 - Canela. Salvador, BA, Brasil. CEP: 40231-300