Abstract T MP108: Decreasing Door-to-Needle Time a Collaborative Approach
Background: The Target Stroke guidelines recommend treatment initiation within 60 minutes of patients’ arrival in the emergency department (ED). In May 2012 we began an indepth review of our acute stroke (“Code Gray”) care process in an effort to improve our door to needle time (DTN).
Objectives: To decrease the DTN time to 45 minutes or less, treating 50% or more of our patients within that time frame.
Methods: A multi-disciplinary performance improvement team was formed and trained in Six Sigma methodology. A retrospective review of baseline data identified 75 data points spanning the 19- month period January 2011 to July 2012. A pilot study was initiated, which included tPA-eligible patients arriving in the ED who could be treated within 3-4.5 hours from the onset of symptoms.
Results: Baseline data indicated that we achieved theTarget Stroke recommendations for 50% of eligible patients. The mean DTN time was 61 minutes, and standard deviation of 18 minutes. The average “Door to CT results” was 29 minutes. However there was significant variation in “Door to CT results” and “CT Results to Drug” times, contributing significantly to delays in DTN. It was determined that bringing the patient directly to CT on the EMS stretcher would be a high impact intervention. This new process incorporated more timely patient registration and immediate assessment by the ED physician. In our pilot group consisting of the 44 patients where pre-notification was available, the, average DTN time was 38 minutes, with the lowest DTN of 14 minutes. An additional 29 patients, for whom pre-notification was not provided, were not included in the pilot but benefited from this process change with an average DTN of 49 minutes. Average time for “Door to CT results” has decreased from the baseline average of 29 minutes down to 7 minutes for the patients in the pilot and to 20 minutes for all patients.
Conclusion: We have made a statistical difference between our baseline and our pilot data. We have decreased our average time by 23 minutes for those patients that we received pre-notification, and we are currently 18 minutes under the national average for all patients combined. While the pilot has been limited to patients with pre-notification, it clearly has benefited all stroke patients.
Author Disclosures: A.N. McCall-Brown: None. R. Felberg: None. O. Eboras: None. L. Bertsch: None. J. Volturo: None. E. Hogan: None.
- © 2015 by American Heart Association, Inc.