Abstract TP396: Small Changes Yield Big Dividends
Background and Purpose: As a Primary Stroke Center (PSC) serving central Iowa, our facility cares for nearly 800 stroke patients per year. We are also a chest pain and trauma center and our Emergency Department (ED) processes over 86,000 visits per year. High volumes often result in multiple bed and staff assignment changes, flexing with acuity and flow of patients entering the ED, creating some confusion on the part of our EMS partners arriving with stroke alert patients. This led to a perceived indifference on the part of the ED staff. This concern was related to the stroke coordinator by EMS leadership generating a frank discussion with ED leadership.
Methods and Results: Leadership in the ED, EMS, and the stroke coordinator met to discuss EMS perceptions and concerns. While the PSC was clearly meeting national goals in terms of door to CT and needle times, the negative perception on the part of EMS had the potential to impact destination decisions in the field which could ultimately negatively affect patients. These discussions resulted in a process change. It was determined that an overhead page (which was already in place for trauma alerts) should be implemented for all time critical diagnoses, thereby creating a consistent communication method. Additionally, a page was generated to the stroke team and a physician to physician call was placed when the patient arrived in the ED after rapid assessment.
Outcomes: As a direct result of this process change, door to CT times were decreased to an average of 6 minutes (an improvement of approximately 3 minutes) and a door to needle time to an average of 40 minutes (a decrease of 12 minutes). The Rapid Response Team is now attending stroke alerts in order to facilitate rapid treatment. There is an increased awareness by hospital administration and staff regarding the high volume of patients served, and a heightened awareness on the part of our patients and their families related to the emergent treatment of stroke. EMS leadership reports a significant improvement in satisfaction among providers leading to an increase in patients arriving via EMS.
Conclusion: A simple change in stroke alert process has yielded multiple positive outcomes.
Author Disclosures: T. Hamm: None. B. Helland: None.
- © 2016 by American Heart Association, Inc.