Abstract T P336: Pursuit of Door to Needle Reductions through Enhanced Partnerships: A Paradigm Shift
Purpose: Ischemic stroke patients, who meet criteria to be administered t-PA, should receive a patient-focused effort that advocates for quality, efficacious treatment. It’s essential to continuously evaluate the impact that a model of care delivery has on clinical outcomes. Healthcare reform may dictate utilization of current resources and often allocation of those resources are re-aligned to meet financial targets. The model of care delivery referenced in this study includes primary responders on a code stroke team that have transitioned from a unit based resource to an emergency room resource. Quality outcomes are a priority and overcoming obstacles to prevent delays in meeting the national benchmark of door to needle time in less than 60 minutes requires enhanced partnerships. The purpose of this study was to determine the effects that a model of care delivery for acute stroke response had on door to needle time and identify the impact from utilization of value stream mapping.
Methods: Retrospective chart reviews were conducted on stroke patients that received t-PA over a 5 year period. Comparative analysis of all response times were reviewed for trends and opportunities that may have also been impacted by the model of care delivery. Immediate review and feedback on every case served as a catalyst for quality improvement, engaging all providers to implement changes that would improve door to needle times. Response time data was analyzed to determine if there was statistical significance, such that all opportunities for improvement to reduce needle to door time to < 60 minutes could be addressed with action plans.
Results: Percentage compliance of door to needle time within 60 minutes increased from 17% to 63% during the study period.
Opportunities to further reduce door to needle times reveal potential decrease of key response times by approximately 20 minutes. This is evidenced by continued improvement in the average door to needle time by 15 minutes during the study period.
Conclusion: Transition of care delivery models with ownership and team engagement can result in a paradigm shift that indicates effective action plans for quality improvement in door to needle times. Further insight from value mapping serves as a guide for lean processes.
Author Disclosures: C.W. Small: None. S.D. Freeman: None. J.A. March: Consultant/Advisory Board; Modest; Chairman for the Board of Director Continuing Education Coordinating Board of EMS, Editorial Board Prehospital Emergency Care Journal National Association of EMS Physicians. A.K. Foss: None. F. Bogenn: None. B. Landry: None. D.L. Price: None. V.L. Cogdell: None.
- © 2015 by American Heart Association, Inc.