Abstract WP241: Value Stream Analysis Reduces Door-To-Needle Times in Acute Stroke
Introduction: An important goal in treating acute stroke is minimizing door-to-needle times, consistent with evidence based practice and quality goals. Utilizing methods to streamline the process of patient and information flow in the emergency department (ED) is necessary to reduce treatment times.
Hypothesis: Use of value stream analysis to improve efficiency in processing acute stroke patients in the ED should reduce door-to-needle times.
Methods: Value stream is the movement of patient and information to deliver the desired outcome. The process from door to treatment was divided into individual steps. We defined process time (the time each step takes) and wait time (the time between each step). The mission was to identify which steps were absolutely necessary before a patient could receive IV-tPA, and to streamline those steps to reduce the process time. All patients who received IV-tPA in 2011 and thus far in 2012 are shown in the graph. Each bar represents an individual patient.
Results: Prior to stream analysis, our average door-to-needle time was 122.2 minutes. After the process was rolled-out, the average door-to-needle time was down to 73.8 minutes. Before stream analysis we treated 7.6% of our IV-tPA patients in less than 60 minutes. After analysis we treated 69.2% of patients in less than 60 minutes. The number of patients treated rose from 11 in 2011 (5%) to 17 thus far in 2012 (mid-year, projected 15%). We also found that the number of thrombectomy treated patients was reduced from 39% prior to analysis to 23% following analysis, perhaps partly due to reduced processing time and more patients evaluated within the window for IV-tPA.
Conclusion: Streamlining the process of patient flow in the ED by value stream analysis resulted in several outcome improvements in acute stroke patients:
1) Reduced door-to-needle times.
2) Increased number of patients treated within the golden hour.
3) Increased number of patients treated with IV-tPA.
- © 2012 by American Heart Association, Inc.