Abstract T P284: Use of Lean Six Sigma in a Primary Stroke Center: Improving the Time to Care

Abstract

Background: Stroke is the fourth leading cause of death and the leading cause of severe long term disability for adults in the US. Each minute of brain ischemia can lead to varying degrees of neurological compromise. The purpose of this study was to identify time wasting work flow processes during the evaluation phase for the suspected stroke patient (SSP) and to minimize or eliminate them. The National Institute of Neurological Disorders and Stroke (NINDS) time targets were used as the benchmark for this research. Methods: An audit of 98 emergency department patient records revealed variation and inconsistency in meeting expected time targets that included door to: physician evaluation, stroke alert call, CT completion, CT interpretation, all lab and diagnostic completion. Lean Six Sigma methodologies were used and a two day Kaizen Event was held with an interprofessional process improvement team empowered to identify and reduce wastes, synchronize work flow processes, manage variability, devise communication and sustainability plans. A quasi-experimental pretest posttest design was used with a non-probability, structured method of sampling to select all pre- and post-intervention SSPs presenting to the emergency department for symptom evaluation ( N = 222). Results: Results indicated that time was saved and variation decreased in all areas during the last 3 weeks of the study. The post-intervention work flow redesign group was faster than the baseline group at evaluating the SSP across all time targets, F (5, 642) = 2.98, p = .01 and two were significantly faster: lab completion ( M pre = 48.10, SD = 20.70; M post = 35.54, SD = 14.80) and all diagnostics completion ( M pre = 49.74, SD = 20.26; M post = 37.77, SD = 13.76); SE decreased (3.38 to 2.84) indicating decreased work flow variability. Conclusion: Work flow process redesign conceived and implemented by front line care providers resulted in substantial time savings for both patients and staff. Whether patients chose to receive a thrombolytic agent as a treatment modality, each must be assured that time delays do not deny them this therapy option. Time efficient, value added activities for this patient translates into a greater chance to preserve brain tissue, function and quality of life.