Reduction of door-to-needle times in acute ischemic strokes

Abstract

<p>Poster presentation</p><p>Session J presented Wednesday, October 2, 11:30 am-12:30 pm</p><p>Purpose: Our Emergency Department aims to exceed the goals of the American Heart Association and American Stroke Association national quality improvement initiative to improve acute ischemic stroke care. Our Emergency Department recognized that there was an opportunity to improve the Emergency Department “Code Stroke” process in order to reduce door-to-needle times. </p><p> Design: Performance Improvement Project, Process Improvement Project, with Staff Education. </p><p> Setting: Suburban, Level II Trauma Center, Magnet Designated, Integrated Comprehensive Stroke Center. </p><p>Participants/Subjects: All ED Staff and ED 'Code Stroke' patients who received tPA participated in this project. </p><p> Methods: Basic procedure: An evidence based project was conducted by utilizing robust quality improvement methodology. In order to determine barriers that prolonged door-to-needle times, our team measured door-to-doctor, door-to-Computed Tomography and door-to-lab times. From that data, a lean department-wide process was established to improve patient outcomes. </p><p> Results/Outcomes: Main findings: The data was analyzed for three months prior to implementation showing an average of 63 minutes for door-to-needle. At three months post-implementation, the average time for door-to-needle was reduced to 43 minutes. Continuous ongoing measurements at twelve months show a further reduction to 34 minutes. </p><p>Implications: Conclusions: With implementation of the new “Code Stroke” process and multidisciplinary education, the Emergency Department successfully reduced door-to-needed times by 38% over the initial twelve month period.</p>