Abstract WP250: Hospital System Collaborative has Positive Impact on Door to Needle Times
Background: Target Stroke is a National quality initiative to increase administration of IV rtPA to within 60 minutes from arrival on at least 50% of eligible ischemic stroke patients. Historically, the National statistic was approximately 25%. The Baptist Health System (BHS) benchmark in January 2010 was at 16.9%. This statistic is for a five hospital system with 1,674 licensed beds and one provider number. BHS has one Stroke Medical Director and follows the same standard of care and stroke order sets at all locations. We will describe the process applied across BHS to decrease door to needle times.
Methods: One hospital Emergency Department’s (ED) Physician Champion, Director and nursing staff used LEAN methodology to outline present state and streamline the process to eliminate wasted time. Our process already consisted of pre-notification from Emergency Medical Services (EMS) with the estimated time of arrival and a stroke alert page. In our new process, the ED Physician (EDP) and RN1 meet EMS in ambulance bay for a quick assessment. The patient is taken directly to CT scan by RN1 and EMS1. Concurrently, EMS2 reports off to RN2 while assembling the equipment and contacting Specialists On Call (SOC) for the neurology consult. The CT technician notifies the Radiologist of the stroke alert and sends the films to SOC. Upon patient return from CT, the SOC video consultation begins. If a high probability of IV rtPA administration exists per EDP, the rtPA is reconstituted awaiting SOC recommendations. This process was piloted before being duplicated at the other four hospitals.
Results: BHS achieved Target Stroke Honor Roll status for third quarter 2010 with 71.4% (n = 20/24) of eligible patients treated with door to needle time of 60 minutes or less. Median time was 48.5 minutes. BHS sustained Target Stroke Honor Roll status for July 2010 through June 2011, at 56.6% (n = 56/99) with a median time of 56 minutes.
Conclusion: BHS was the first hospital in Texas to be awarded the Target Stroke Honor Roll. Incorporating LEAN methodology to eliminate waste, develop guidelines, actions, time durations, and collaboration across the hospital system is an effective means to decrease door to needle time.
- © 2012 by American Heart Association, Inc.