Abstract 2317: A Multidisciplinary Team Approach to Improving Laboratory Results and Thrombolytic Treatment in Acute Code Stroke Patients.
Despite improvement in acute stroke care, stroke remains the third major cause of death and leading cause of disability nationwide. An increase in the number of certified Primary Stroke Centers (PSC) over the past years has been credited for the improvement. Los Angeles County proactively implemented the Approved Stroke Center Network in which Emergency Medical Systems may passes non-certified PCS for acute stroke treatments. Our hospital’s journey towards building a stroke program began in early 2008, and in 2009 a CODE STROKE algorithm was implemented. Over the past two years, the team has strived to continuously improve ‘door to needle’ times. Opportunity to improve door-to-lab results was recognized so we sought to investigate and identify barrier(s)/reason(s) for delays.
Methods The LEAN Six Sigma team guided our multidisciplinary committee for identifying contributing delays. A review of the clinical pathway from the patient’s arrival time (door) and activation of Code Stroke are time-stamped at every step. Phase I identified delays with phlebotomist transit times. The laboratory management addressed this issue by reinforcing the need to expedite the specimen collection, transit time and processing. Some improvement was noted in the door-to-lab results time but significant delays remained a problem. Phase II incorporated lab draws being performed prior to the patient going for their CT scan. Phase III involves utilization of an iStat unit within the emergency department for analysis of a CHEM 8 panel.
Results Analysis of data initially showed door-to-lab results had a median time of 52 minutes, with 38% having results within 45 minutes. Ten patients received tPA within median times of 66 minutes, with 53% receiving tPA within 60 minutes. In 2010 action plans initiated yielded significant improvements with door-to-lab results median times of 44 minutes, 64% having lab results within 45 minutes. Twenty one patients received tPA within a median time of 55 minutes, and 70% having received tPA within 60 minutes.
Conclusion The multidisciplinary stroke team identified barriers and implemented process changes yielding improvements in door-to-lab results that in turn resulted in overall improvements in tPA treatment times. Data collection and process evaluation continue.
- © 2012 by American Heart Association, Inc.