Abstract 2544: CT Brain Alert Specific for Stroke Significantly Improves Door to CT Brain Time in a Rural Hospital Setting

Abstract

P> National Studies from the American Heart Association/American Stroke Association's Get with the Guidelines quality improvement initiatives show that brain imaging in acute stroke care is not performed within the recommended 25 minutes in the majority of cases and quality improvement initiatives need to focus on reducing door to imaging times. UPMC Northwest, a 126 bed rural hospital serving Northwest Pennsylvania, began a quality assurance initiative for monitoring CT brain times in 2003 to evaluate guideline compliance and identify areas of change to improve door to CT brain start times in acute stroke patients. Based on the data collected on door to CT start times from STAR radiology information system and GWTG-Stroke data base, the stroke team committee convened to identify barriers, discuss process change and to ensure the implementation of change within the institution. A potential barrier identified was that all CT brain studies were ordered STAT in the Emergency Service setting and CT staff could not identify stroke verses non-stroke patients quickly. The stroke Team Committee assessed the hypothesis that development of an alert system enabling CT staff to quickly identify acute stroke patients would improve door to CT start times. An acute stroke alert protocol was added to the CT brain scan order to include “acute stroke” in the order set. The stroke alert enabled CT staff to quickly identify an order for the acute stroke patient and prepare the CT scanner. The acute stroke protocol was activated in 2004 and data collected on 1481 patients from October 2004 to December 2010 showed improvement of door to CT start times from 38 minutes in 2004 to 9.5 minutes in 2010, an improvement of 28.5 minutes. Other initiatives instituted to reduce acquisition time of critical CT brain scan information included a contracted tele-radiology group for round the clock radiologist coverage, phone calls from Emergency Service to CT staff to alert of an acute stroke patient prior to arrival and education for all hospital staff on acute stroke treatment guidelines. In conclusion, implementation of an acute stroke alert for CT brain has significantly decreased the time from door to CT brain scan for acute stroke patients entering UPMC Northwest, facilitating brain saving treatment and promoting awareness for ongoing stroke care quality improvement.