Abstract P864: Use of the American Stroke Association Patient Time Tracker Tool to Reduce DTN Times in Stroke

Abstract

Introduction: More expedient door-to-needle (DTN) times with IV Alteplase in stroke have proven to result in better patient outcomes. Despite multiple bodies of evidence that support this conclusion, there remains challenges in accomplishing rapid times to treatment. The American Stroke Association (ASA) has developed in Target Stroke Phase III, criteria that requires DTN times within 45 minutes for at least 75% of applicable patients and DTN times within 30 minutes for at least 50 % of applicable patients. Despite various quality improvement projects many hospitals still struggle to shorten DTN times. Objective: An internal review of data from January 2019 to December 2019 revealed that despite more experience in acute stroke thrombolytic therapy, treatment times were prolonged. In order to shorten DTN times, a method to highlight time targets in evaluation and treatment was instituted. The ASA Time Tracker Tool was utilized to provide feedback on all stroke patients receiving IV Alteplase with the goal of better exploring reasons for delay in a timely manner that included input from the treatment team. Methods: In March 2020 the utilization of the ASA Time Tracker Tool was introduced. The tool was completed for every stroke patient receiving IV t-PA within 48-72 hours of thrombolytic administration. Each case included reasons for delay that was documented in the EMR. Professional staff including nursing and medicine were provided each case and asked for input regarding perceived delays to treatment to better discern obstacles to care. Results: Prior to institution of the ASA Time Tracker Tool the median DTN time was 41.7 minutes for 2019. After the tool was instituted the DTN times fell in Quarter 2 2020 to 38 minutes. Residents and nurses alike verbalized positively about receiving the tool as a mechanism for valuable feedback as well as an opportunity to provide their own input on potentially correctable areas to reduce DTN times. Conclusion: The use of the ASA Time Tracker Tool to share crucial time sensitive targets in the acute treatment of ischemic stroke is one method to reduce DTN times. Further study is needed to determine frequently occurring obstacles from the treatment team’s point of view with attention to correcting those barriers that prolong DTN times.