Abstract T P257: Intramural Competition Significantly Reduces Door-to-Needle Time: Results From Adventist National Stroke Forum Door-to-Needle Time Challenge Process Improvement Project.
Background: Lower Door-to-needle times (DTNT) are associated with better outcomes. The Adventist National Stroke Forum (ANSF) was formed in 2011 to improve stroke care throughout Adventist hospitals.
Methods: In 2011, ANSF completed a 4-month regional DTNT reduction competition among 7 Orlando Adventist hospitals. In 2013, ANSF conducted a 6 month national DTNT Competition following : Shawnee Mission Medical Center (KS), Florida Hospital Zephyrhills, Adventist Hinsdale Hospital (IL), Florida Hospital East Orlando, Glendale Adventist Medical Center (CA), Florida Hospital Orlando, and Florida Hospital Altamonte. Stroke teams implemented ways to reduce DTNT. Parenchymal hemorrhage type 2 (PH2) rates and percentage of stroke mimics treated with IV tPA were measured 4-6 months before and 4-6 months during both competitions. Comparison of DTNT between televideo and non-televideo cases is being completed in the national competition.
Results: From 6/2011 to 10/2011 the regional study compared data from 27 tPA cases 4 months “before” the study to 28 tPA cases “during” the study. Regional DTNT “before” average (103 min) and median (95 min) times dropped 26% and 18% respectively to “during” average (76 min) and median (76 min). The odds of a DTNT of <60 minutes increased from 7% pre- competition to 33% during the regional competition in Orlando Adventist hospitals (2 of 28 vs. 9 of 27, OR=6.5, 95% CI 1.26 to 33.7). There was no regional increase in either PH2 or treated stroke mimics rates (1 of 28 before vs. 0 of 27 during for both PH2 and stroke mimics treated, OR=2.8947, 95% CI 0.11 to 74.2).
Conclusion: A regional DTNT competition among Adventist hospitals produced a significant increase in percentage of patients receiving tPA with DTNT <60 min with no increase in PH-2 or number of stroke mimics treated. Final national competition results will be presented to determine 1) if regional DTNT competition benefits can be generalized nationally, 2) if 2011 Regional DTNT competition gains were sustained among Orlando Adventist hospitals, and 3) if televideo was associated with lower DTNT's.
Author Disclosures: E. Allen: Speakers' Bureau; Significant; genentech. R. Lovec: None. C. Jones: None. I. Acosta: None. K. Lubben: None. M. Grace: None. B. VanCattenburch: None. M. Jocson: None. J.D. Claunch: None. D. Richards: None. P. Garrett: None. A.I. Qureshi: None.
- © 2014 by American Heart Association, Inc.