Abstract WP334: The Positive Impact of Role Definition and Communication on Door to Needle Times in Acute Stroke Patients Receiving Intravenous Alteplase
Background and Issues: Intravenous IV t-PA (IV t-PA) is indicated for the management of acute stroke in adults for improving neurological recovery and reducing the incidence of disability. The decision making process prior to administration of IV t-PA is complex and requires analysis of critical patient data to ensure safe administration. Communication of patient data is shared among many different departments and individual team members. The goal of administering IV t-PA within 60 minutes of patient arrival is heavily dependent upon the shared knowledge of this goal and the required patient data necessary for the treatment decision. From January 2011 through March 2012, 60 percent (76 of 127 patients) of our IV t-PA patients received treatment within 60 minutes. Our median door to treatment time remained at 58 minutes for the same 15 months.
Purpose: The purpose of our team was to identify role responsibilities and points of essential communication of information to meet a goal of 75 percent of eligible patients to safely receive IV t-PA within 60 minutes of presentation to the hospital.
Methods: Analysis of patients receiving IV t-PA during 2011 revealed 64.8 percent of TPA was administration during late afternoon and evening hours when stroke team resources were most lean. The importance of communication between the emergency department staff and responding stroke team was identified. After flow-charting the process, responsibilities for key processes and intentional points of communication required between team members were defined without regard to time of day stroke patients present to the hospital. Each department received education of their responsibilities.
Results: In the first quarter after staff education and acknowledgement of their roles and required points of communication, 68.4 percent (13 of 19) of our IV t-PA patients received treatment within the goal of 60 minutes. The median time from patient presentation to IV t-PA administration dropped to 49 minutes suggesting decrease in variability of the process.
Conclusion: Defining role responsibilities to ensure effective communication among stroke team members improves time to treatment decisions in eligible stroke patients.
- © 2012 by American Heart Association, Inc.