Abstract 2993: Effects of Education and Immediate Feedback on Improved rt-PA Door-to-Needle Time
Background & Issues: The American Stroke Association reports earlier administration of intravenous rt-PA following symptom onset is associated with greater functional recovery. The Target: Stroke Campaign has identified a door-to-needle goal of 60 minutes or less. Our adoption of the Target: Stroke guidelines led to the improvement of emergency staff awareness and interventions for immediate feedback and correction of misperceptions of goal time for rt-PA administration and improved results.
Purpose: To improve door-to-needle time to 60 minutes or less.
Methods: In April 2010, we initiated a process to improve door-to-needle time for rt-PA administration within 60 minutes of arrival to Emergency Department (ED) for anyone presenting with indication of stroke. Target: Stroke guidelines are implemented for initial patient evaluation within 10 minutes of arrival to ED, stroke team activation within 15 minutes of arrival, CT scan within 25 minutes of arrival, and interpretation of CT scan within 45 minutes. First responders notify the Emergency Department of a possible stroke patient enroute. The triage nurse activates the Stroke Team through mass paging the team members. The Stroke Team Nurse assesses the patient, determines the onset of symptom time and possible rt-PA exclusions, follows the patient to CT Scan notifying the neurologist of CT scan results, and initiates the immediate discussion between the Emergency Physician and neurologist to determine if rt-PA is appropriate. If rt-PA is administered, immediate feedback is given to all stroke team members using a door-to-needle tracking form. All time delays are reviewed by the Stroke Team Medical Director to determine causes for delay. The Stroke Team meets to determine where improvements can be made.
Results: From April 2010 through June 2011, door-to-needle time was decreased from 107.75 minutes to 52 minutes per quarter average.
Conclusions: Improvements were realized following the extensive education of the Emergency Department with clarification of door-to-needle goal. This resulted in the ED staff’s design and implementation of a standardized process for following each stroke emergency, including early stroke team activation for patients presenting with any sign of acute stroke and the early initiation of a second intravenous line.
- © 2012 by American Heart Association, Inc.