Abstract W P245: Process Improvement to Reduce Time Interval From Hospital Arrival to Intravenous Thrombolysis in Acute Stroke
Background: Rapid administration of intravenous recombinant tissue plasminogen (rt-PA) is an effective way to enhance thrombolytic efficacy in stroke patients. We had already shown that a stroke code program based on the computerized physician order entry system could reduce time interval from hospital arrival to IV thrombolysis. We investigated that process improvement, which is an activity to improve existing process by making changes, could further reduce in-hospital time delay in thrombolytic therapy.
Methods: During the first period (Jan. 2007 - Dec. 2009), we set the target time from emergency department (ED) arrival to IV thrombolysis at 40 minutes, monitored time intervals to evaluations and treatment at weekly stroke conference and determined the possible factors that were associated with time delay in cases who did not receive IV thrombolysis within 40 minutes. During the second period (Jan. 2010 - Dec. 2012), after review of factors of time delay during the first period, we implemented a tool for explanation to patients and their families, which included a standardized script and a Visual Decision Aid for tPA treatment (developed by UCLA stroke center).
Results: After setting the target time and continuous monitoring of the process, median time from ED arrival to IV thrombolysis was reduced from 63 min to 45 min (p<0.001). During the first period, the most common cause of the time delay was delayed decision of family (15.9%). After implementation of the standardized patient explanation tool, the proportion of the time delay due to the delayed decision was significantly reduced from 15.9% to 3.3% (p=0.005), which resulted in further reduction of time interval from ED arrival to IV thrombolysis to 43 min (p=0.001).
Conclusion: Continuous process improvement activity was effective in reduction of time intervals from ED arrival to IV thrombolysis in acute stroke patients. Setting target time with continuous monitoring of the performance and a standardized explanation for patients and their families using a script and a Visual Decision Aid were helpful to improve stroke team performance and reduction of time delays.
Author Disclosures: E. Kim: None. K. Lee: None. D. Song: None. Y. Kim: None. H. Cho: None. K. Lee: None. H. Nam: None. J. Heo: None.
- © 2014 by American Heart Association, Inc.