Abstract T P288: Improvement of Door to Groin Time for Endovascular Therapy in Acute Ischemic Stroke Using Quality Improvement Methods
Objective: Time has been identified as a key variable to the success endovascular treatment of acute ischemic stroke. This project was designed to reduce the time from patient arrival to groin puncture for these treatments at a single academic hospital.
Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team was created to identify ways to reduce time from patient presentation to groin puncture. A comparison of pre-intervention and post-intervention times was performed. Pre-intervention patients were retrospectively identified using existing databases and post-intervention patients were prospectively identified. Process maps were created to identify areas of delay. Debriefs helped to indentify future process improvements. Four PDSA cycles have been completed. Stroke neurologists instituted an early notification of IR physicians and a unified imaging protocol. Other interventions included a group paging system, standardized order sets, education within each discipline, improved communication, standardized stroke tray set-up, and streamlining preparation of the patients prior to transportation from the ED.
Results: The median time from presentation to groin puncture was reduced from 126 minutes to 92 minutes. MRI imaging was associated with a long pre-intervention time to groin puncture, with a median of 182 minutes that was reduced to 99 minutes. Procedures outside of normal business hours were associated with long time to groin puncture, with a median time of 149 minutes that was reduced to 125 minutes.
Conclusions: A reduction of time from presentation to groin puncture is possible using PDSA cycles. This QI project decreased time to groin puncture by 26%, showing that a systematic evaluation of institutional-specific workflow can improve the process preceding a time-sensitive procedure.
Author Disclosures: J.R. Simpson: None. A. Graves: None. A.N. Burrus: None. D.E. Case: None. C.J. Denton: None. L. Gebhard: None. M.D. Grant: None. D.A. Smith: None. R.K. Gupta: None.
- © 2014 by American Heart Association, Inc.