Abstract T P216: A Program for Sustaining Improvements in Acute Stroke Treatment
Introduction: Efficacy of thrombolytic therapy in acute stroke patients improves when time to treatment is reduced. Previously we demonstrated improved treatment outcomes after utilizing value stream mapping to improve the efficacy of processing acute stroke patients in the emergency department (ED). We then developed programs to provide sustainability of this process.
Hypothesis: Attention to process in ED management of acute stroke patients through communication, feedback and multidisciplinary stroke meetings should promote sustainability of the process and improve outcome measures.
Methods: After formally implementing value stream mapping technology we took steps to maintain improved processing of acute stroke patients and improved outcomes. We developed mechanisms to communicate stroke treatment outcomes to medical staff at all levels. Our stroke coordinator meets regularly with all medical staff involved after a treated case to provide feedback. We have regularly scheduled multidisciplinary stroke meetings where successes are shared and opportunities are discussed. We have scheduled stroke quality meetings to discuss opportunities and communicate with staff involved.
Results: As a result of constant surveillance, our door to needle (DTN) times have continued to go down, most recently to 42.9 minutes (graph). The number of patients treated with IV-tPA increased from 5% to 14% following implementation of value stream technology, and is currently at 15%. The percent of patients treated within the golden hour has continued to rise, and has now reached 78%.
Conclusions: Improved outcome measures in acute stroke can be maintained and further improved by regular communication and feedback provided to all members of the stroke team. This fosters a competitive spirit and a sense of ownership that helps to sustain the process. Through this effort we continue to see increases in the number of patients treated and a reduction in treatment times.
Author Disclosures: A. Bentaleb: None. L. Golding: None. R. Jackson: None. N. Desmond: None. L.B. Eberly: None.
- © 2015 by American Heart Association, Inc.