Abstract WP361: The Golden Hour: A Team-Based Approach to Targeting Door to Needle Time
Background and Issues: Restoring perfusion to the brain is key to the patient’s recovery and has been at the forefront of stroke treatment and research for the past decade. In 2010, AHA/ASA challenged acute stroke programs to reduce their IV t-PA door-to-needle times. Developing an interdisciplinary, team-based approach has helped our stroke program meet, and at times, exceed the door-to-needle time goal for IV t-PA.
Purpose: In 2010, in response to the AHA goal, the team re-designed the processes for ordering and administering IV t-PA. Critical improvements of the current process were identified such as order entry, order confirmation, patient eligibility and staff education.
Methods: When a patient is deemed a potential candidate for t-PA, the order is placed for the medication. A “stat” sticker was added to the t-PA order sheet, to place the medication in a priority queue within the pharmacy. A phone call is placed to the pharmacist to confirm receipt of the order. Diagnostic testing and further medical evaluation takes place and informed consent is obtained while the medication is being prepared by the pharmacist. The ED staff was educated regarding the AHA/ASA goal and the importance of rapid patient triage, prompt initiation of the stroke alert process including initiating the t-PA order sets, coordination of diagnostic evaluation and the administration of t-PA.
Results: In 2008, our door to needle time was 92 minutes. From 2009 to 2010 our time decreased by almost 10 minutes. In 2011, despite a record high of t-PA cases, our time decreased by almost 30 minutes. Aultman was a recipient of the Target: Stroke award in 2011 and we have maintained our Gold Plus status for Get With The Guidelines performance for three years running.
Conclusions: Developing a team approach and identifying opportunities for improvement for care are essential in the success of a stroke program. In 2012, Aultman has seen a slight increase in the door to tPA time due to the implementation of electronic physician order entry. Effective and efficient stroke care remains our program’s goal and we strive for excellence in stroke care.
- © 2012 by American Heart Association, Inc.