Abstract 3918: Use of Data Timeline as Tool for Improved Door-to-Needle Times

Abstract

Background and Issues: NIH - NINDS have benchmarked time targets for use of Activase (tPA) for potential thrombolysis in patients triaged as an AIS with a door to needle (DTN) time of 60 minutes or less. It has been reported that the most referenced challenges faced in ED and Stroke Centers involves balancing time urgency with synching of key diagnostics within the hospital. The Joint Commission (JC) recommends that quality data collected also be shared with involved inter-disciplinary team members. This data is required to JC on a quarterly basis, but there is not a recommended method of using the data internally. Purpose: The purpose of the program improvement initiative was 1.) decrease the DTN time to less than 60 minutes in at least or greater than 50% of all patients receiving tPA and 2.) develop a method that shares program quality points internally with all disciplines, department leaders and front-line staff, with a model that simplifies reporting, increases report turn-around time and engages staff in processs improvement. Methods: In 2008, it was noted that door to needle times for tPA cases were increasing, and the rate of administration was decreasing. Various report formats were developed in a means to supply the data points to stake holders, with limited success. In 2009, a new reporting tool was configured to present individual DTN timelines for each tPA patient, and then distributed to the Inter-disciplinary Stroke Performance Improvement Committee within 48 hours. Results: The multidisciplinary nature of stroke care requires interaction and coordination of all members of the team to meet time sensitive performance measures. But the collection of data and disseminating that data in formal, infrequent committee meetings with department leaders does not directly result in program improvement. By developing a tool that highlights critical timeline benchmarks and then promptly distribute team-wide, performance outliers were identified in nearly real-time and addressed effectively. A second result is that each department made efforts to avoid being noted as a “breakdown” point. Some departments reported the development of a competitive approach within the department to post the “best times”. This process resulted in marked improvement in compliance with the 60 minutes DTN time, and may have resulted in more aggressive approach to using tPA, as evidenced by increase rate of treatment. Conclusions: The rapid collection and distribution of individual patient timeline data has proven to be a quantifiable benefit with an increased thrombolytic administration percentage, with concomitant decrease in door-to-needle time. In addition, internally sharing information has resulted in an improved department as well as individual staff investment in stroke patient care and program improvement.