Time is Brain, Team is Key

Abstract

Evidence-based Practice Abstract Purpose: The American Heart Association has set 60 minutes as the goal for “door to needle” time for the treatment of Acute Ischemic Stroke. The objective of this quality assurance project was to significantly reduce the 120 minute ‘processing’ time for stroke patients from time of arrival in a Level I Trauma Center to the administration of t-PA. Design: Quality assurance project using a multidisciplinary team approach. Setting: 870-bed urban healthcare system and Level One Trauma Center; Primary Stroke Center. Participants: In order to identify and problem-solve delays in care, we enlisted the participation of every internal AND external entity that impacted the care of our stroke patients. These included the local area Emergency Medical Systems, Laboratory, Radiology, Clinical Administrator (House Supervisor), Rapid Response Team, Pharmacy and, of course, all staff in the Adult Emergency Department (N=~250). Methods: Once it was determined that a change needed to occur, our ED Leadership team scrutinized each step in the process-- from initiation of the 911 call in the community to the administration of t-PA. With the assistance of ED staff, time guzzlers were identified and strategies proposed to reduce them. Internal and external partners were identified; champions included the EMS Medical Director and the Director of Pathology. Inter-departmental barriers were discussed and reduced through collaborative problem-solving; policies and procedures were written, education was created and disseminated and supplies were standardized. Results/Outcomes: Results have been remarkable primarily because of the multidisciplinary team buy-in to the new process. For example, the pre-hospital (EMS) lab draw has helped reduced our lab turnaround time from 43 minutes to 31. Keeping the patient on the EMS stretcher from arrival in the ED to CT has reduced door to CT time from 19 to 11 minutes. Before the initiation of the project, the door to treatment with t-PA was 120 minutes. This was reduced to 40 minutes within the first month and sustained at less than 60 minutes for six months after its commencement. (Additional results will be available on the poster at the conference.) Implications: Key to our success was creating a coordinated, choreographed process that actively sought the assistance of any discipline or department that impacted the care of our Acute Ischemic Stroke patient. The outcomes speak for themselves; as does our subsequent recognition on the American Heart Association’s Target Stroke Honor Roll.