Abstract WP339: Reducing Door-to-Needle Time for Acute Ischemic Stroke Thrombolysis in a Community Hospital

Reducing door-to-needle time [DTNT] for delivery of IV t-PA to acute ischemic stroke [AIS] patients improves functional outcome [1, 2]. Our community hospital sought to evaluate methods for improving DTNT in a non-academic center. Weekly debriefings of all AIS cases were conducted to develop process improvement strategies using a rapid cycle test of change model; which allows for quickly implementing changes in organizational structure [3]. Paired t-test was used to compare mean DTNT before and after implementation of changes. First, stroke patients arriving by ambulance were transferred directly to CT scan, eliminating the time delay of gurney transfers. The stroke team then started formal stroke debriefs, wherein areas for improvement were sought on an individual basis. In response to a delay due to IV tubing issues, pharmacy included tubing with the t-PA. Next, the algorithm was changed to allow ED staff to order t-PA while neurologist was en route. Later, a neurologist was assigned to be on-site at the hospital for immediate response. Pharmacy began hand delivering t-pa after a delivery delay due to miscommunication. After triage delays for atypical strokes, ED began pre-shift nursing messages and displayed posters that emphasized atypical stroke symptoms. Pharmacy designated one phone number to quickly communicate t-PA was to be given. The process improvements resulted in a significant reduction of average monthly DTNT by 7.56 minutes (p = 0.02) (Figure 1). Weekly debriefings of AIS cases lead to policy changes which significantly reduced DTNT in our community hospital. Saver, J.L., et al.: The “Golden Hour” and Acute Brain Ischemia; Stroke. 2010;41:1431-1439 Lees KR, et al: Time to treatment with intravenous alteplase and outcome in stroke; Lancet. 2010 May 15;375(9727):1695-703. Langley G.L.: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance 2009, 2 nd ed. Jossey Bass, San Francisco