Abstract T P347: "Changing How We've Always Done it" Utilizing Lean Six-Sigma to Improve Door to IV-tPA times

Abstract

Background & Purpose: Changing procedures in a large academic hospital is a difficult process. Our institution sought to improve IV-tPA administration times for patients with acute stroke. The purpose of this Kaizen event was to break down this process and rebuild it with the goal of safely administering IV-tPA consistently within the 60- minute window. Methods: Utilizing the expertise of a lean Six-Sigma trained professional, a team was carefully selected comprising multiple disciplines. After receiving lean Six-Sigma training, this team deconstructed the process of IV-tPA administration, using a mock patient experience, external consultants, and direct observation of other institutions. Delays in treatment were attributed to obtaining multi-modal imaging on arrival and performing multiple examinations by different providers. Data were analyzed using reports from the GWTG national registry. Results: With support from all stakeholders, the group developed a new pathway: ED triage◊CT scan (non-contrast only)◊ED Critical Care Bay. By postponing multi-modal CT imaging until after determining IV-tPA eligibility and treatment, door-to IV-tPA times improved significantly (see Fig. 1). Conclusions: Effecting change in a large academic hospital requires buy-in from multiple departments and administrative levels. Resistance to change was a barrier overcome by enlisting the assistance of nurses, radiology techs, and providers. The lean Six-Sigma process was instrumental in streamlining our process in evaluating and treating patients with acute stroke. This one simple change has improved all of our “door-to” metrics and has allowed us to treat acute ischemic stroke patients more quickly. As a result of this process, other potential projects have been identified, such as improving door to groin puncture times for patients undergoing endovascular treatment.