Abstract T P265: Optimizing Team Expertise to Improve Door to Drug Times for Ischemic Stroke
Background and Purpose: Presbyterian Medical Center (PMC) utilized a multi-faceted team approach in 2012 to reduce door to t-PA times for eligible ischemic stroke patients and achieved a median door to drug time of 55 minutes. In 2013 the team set a new goal of a median door to drug time of 50 minutes. One of the barriers identified by team members was unavailability of t-PA at the bedside, and the team took on the challenge of finding solutions to overcome this obstacle with the support of medical and administrative leadership.
Methods: The team outlined a collaborative process using the Plan Do Study Act model recommending that Pharmacists respond to ED Code Stroke pages with a t-PA tackle box and mix t-PA at the bedside. Concerns with this process included inappropriate utilization of resources and time away from the pharmacy, especially during off-shifts. Advantages included bedside expertise and optimization of patient safety. The team agreed to pilot the process for the first 9 cases (30% of 2012 t-PA cases). The pilot process included 2-way team feedback, recognizing responder pharmacists, and celebrated door to drug time times under 40 minutes with a Target Stroke certificate.
Results: On the first day of implementation there were two simultaneous Code Stroke patients in the ED, and two pharmacy teams responded. One patient was deemed by the Stroke Neurologist to be a t-PA candidate, and had a door to drug time of 37 minutes. Pharmacists felt engaged in the process and respected by the team. After the first nine cases, the median door to drug time was reduced by 32.7% to 37 minutes (from 55 minutes in 2012), and the current “best time” is 19 minutes. Responding pharmacists were surveyed and all agreed or strongly agreed that the new process has made a significant improvement in the care of acute stroke (4.5 / 5 Likert Scale).
Conclusions: These results validated the efforts of the PMC stroke team to further refine t-PA processes to achieve optimal outcomes for acute stroke patients treated at our facility. Through this new process our stroke team responders have become increasingly competitive regarding timely stroke care, opening new avenues to improve median door to drug times even further.
Author Disclosures: D. Sorenson: None. R.B. Raynor: None.
- © 2014 by American Heart Association, Inc.