Abstract 21: Stroke Physician Report Cards Improve Physician Response Times for Thrombolytic Treatment

Abstract

To assess whether direct comparative feedback changes stroke physician behavior to improve Emergency Department (ED) page-to-stroke physician arrival, ED page-to-needle and door-to-needle (DTN) times in thrombolytic therapy for acute ischemic stroke. Background: Rapid thrombolytic therapy improves stroke outcomes. Interplay between ED processes and stroke physician behavior influences treatment times. We noted a broad range of intervals between times the physician was paged, to arrival and treatment among 4 Board-certified Vascular Neurologists at two affiliated Primary Stroke Centers. Method: In January 2013 a physician report card was implemented, comparing each physician to the group’s mean and median time points for all 2012 stroke treatment cases. Report cards were then provided quarterly. The pre-implementation (2012) and post-implementation (2013) intervals for overall and individual median page-to- physician arrival, page-to-needle and DTN times were compared using a Mann-Whitney U test. Included in this analysis were all treatment cases that did not have a documented reason for delay (per Target Stroke criteria). Results: Between the pre and post implementation period, the overall median physician page-to-response time decreased by 8.0 minutes (p=0.001). The range of median difference for individual physician page-to-response time was 3-11 minutes. The overall median physician page-to-needle time decreased by 8.0 minutes (p=0.004). The range for the median difference for individual physician page-to-needle time was 5.5-11 minutes. The overall median door-to-needle time decreased by 5 minutes (p=0.104), however, this was not significant. The range for change in individual physician median door-to-needle times was -1 to 9 minutes. Conclusion: The results show that direct, personal and comparative feedback to stroke physicians influences their page-to-response, page-to-needle times and may affect DTN times. There was a clear trend overall, and the page-to-response and page-to-needle times showed significant improvement. Though our numbers were too small to detect statistical significance for individuals, the benefit of improved treatment times is likely clinically significant.