PDSA Cycle and Implementation of World-wide Best Practices to Achieve Faster Door to Needle (P7.328)

Objective: Using the PDSA (plan, do, study, act) model of performance improvement, to develop a faster door to needle (DTN) time for the acute ischemic stroke patients. Background TPA is the FDA approved treatment for acute ischemic stroke, yet door to needle time improvement has been limited. Methods: Every two week DTN taskforce meetings with emergency department, pharmacy, nursing, radiology, and stroke neurology stakeholders were held starting April 2013. Review of prior tpa cases identified gaps in care delivery. Review of the literature revealed best practices including: pre-screening of patients prior to ED arrival, en route communication with receiving hospital providers, direct to CT scan for select patients, and rapid coordinated decision making. New care processes included triage nurses empowered to activate stroke codes prior to patient arrival, nurses using predefined stroke code order set to activate cascade of diagnostics and imaging, appropriate patients brought directly to CT, neurologist and ED huddle and medical assessment for joint decision making. In situ simulation identified other improvement opportunities. Implementation of new care processes occurred in September 2013 with continued evaluation of results and troubleshooting pitfalls. Results: The collaboration across disciplines continues with every two week meetings now. This has provided a forum that sustains our door to needle improvements. This resulted in a dramatic improvement in door to needle times from 27[percnt] receiving iv tpa (Q2, 2013) to 73[percnt] (Q2, 2014) receiving iv tpa in less than 60 minutes, and DTN= 56 minutes (from 80 minutes). Door to CT was also improved for patients with EMS pre-notification to 94[percnt] of patients receiving CT < 25 minutes. Conclusions We successfully created a delivery model of faster iv tpa with concerted efforts and implementation across multiple disciplines and departments. Further work for other DTN metrics are in place using the same infrastructure. Disclosure: Dr. Tai has nothing to disclose. Dr. Casal has nothing to disclose. Dr. Baumann has nothing to disclose. Dr. Marsh has nothing to disclose. Dr. Albers has received personal compensation for activities with Genentech, Inc. and Lundbeck Research USA, Inc. as an advisor.