Abstract P235: Epidemiologist

Abstract

Reducing Door to CT Times in Rural Hospitals Using a Collaborative Quality Improvement Approach Introduction: Rural hospitals are a critical component of stroke systems of care, and play a key role in the race to treatment within the time windows for stroke. Faster treatment leads to better outcomes for stroke patients and rural hospitals often face unique challenges. Despite limited resources to conduct quality improvement (QI), a group of 13 rural hospitals in a large western state undertook a project to identify opportunities and implement strategies to reduce delays along their leg of the race to treatment. The project focused on reducing the time from the door to the CT scan for stroke patients arriving at rural hospitals. The project’s aim was to achieve a 25-minute door-to-CT median time for 60% of stroke patients, and performance in the 75 th percentile for this national performance benchmark. Methods: The rural hospitals created a collaborative group from their existing QI committee. The group used evidence-based QI strategies, including leadership support, a SMART (specific, measurable, achievable, relevant, and time-based) goal, the plan-do-study-act model, Ishikawa diagrams, and data-driven interventions tailored to each organization. QI Analysts established a baseline for median door-to-CT times then collected monthly aggregate data using a national data collection tool for rural hospitals. Project leads regularly presented data at committee meetings and data were trended from baseline to project end. The project culminated in a conference to share the outcomes, challenges, and strategies used to achieve the project goals. Results: After implementing key QI interventions, the door-to-CT median time went from a baseline of 47 minutes to a median time of 25 minutes in the last two quarters. As a group, the hospitals achieved their goal of performing in the 75th percentile of a large national stroke registry. Conclusion: This project demonstrated that despite resource challenges, rural hospitals can successfully do data-driven QI for stroke and meet national benchmarks. The project implemented crucial elements for successful QI initiatives in rural regions: rurally relevant, self-designed, collaborative, leadership-supported and peer-led.