Abstract TP345: Improving Door to Drug Times for Ischemic Stroke Patients Using a Team Approach
Background and Purpose: Decreasing door to drug times for ischemic stroke patients has been proven to optimize preservation of brain tissue, resulting in better functional outcomes. In prior years, the stroke team focus was to meet or exceed the 50% goal for the Joint Commission measure; patients arriving within 2 hours of last known well receive alteplase within 180 minutes. In the fall of 2011, the Neuroscience Medical Director challenged the team to meet target stroke goals and achieve the gold standard of excellence.
Methods: Guided by the Plan Do Study Act model and principles of shared governance, the team refocused efforts to enhance stakeholder collaboration, educate, and provide monthly evaluation of door to door times. Code Stroke pathways were revised to improve efficiency, and inclusion / exclusion criteria were revised. The team is presented with state and national benchmark best practice data on an ongoing basis. Individual alteplase case feedback sheets are sent to all involved providers and departments, who are encouraged to provide input into the process. All alteplase cases are reviewed during team meetings, and outcomes are shared. Role modeling, physician engagement, positive feedback to team members and celebration of successes instill team motivation and confidence. In June, the program hosted an inaugural Stroke Symposium, where national speakers shared the ‘state of the science’, validating the rationale for improving processes for acute stroke care.
Results: In the first 6 months of 2012, the median door to drug time was reduced by 48% to 55 minutes from 104 minutes in 2011. In the same time period, 10 of 15 patients had alteplase administered in < 60 minutes, versus 2 of 25 in 2011.
Conclusions: Significant improvements in stroke care can be gained by establishing a cohesive team with a shared goal of excellence. Strong leadership, the ability of staff on all levels to be partners in decision making, information sharing, education and recognition are keys to success. Future challenges include ensuring the processes are sustainable, and maintaining team motivation to continue to find opportunities to reduce door to drug times.
- © 2012 by American Heart Association, Inc.