Abstract TP24: Importance Of Staff Engagement And Performance Improvement Model In A High Performing Emergency Department Stroke Center

Abstract

Background and Purpose: As a high-performing Advanced Primary Stroke Center (HPAPSC) an opportunity to explore learnings from local existing strategies on improving door-to-needle times (DTN) will assist in sustaining performance. With the use of Teleneurology technology and an early adopter of Tenecteplase, the APSC has exceeded national benchmarks on DTN. The challenge for a low-volume, HPAPSC is how to sustain performance while increasing the reliability of evidence practices, enhancing staff engagement, and reducing patient harm. Methods: With the availability of evidence-based interventions, the HPAPSC facility adopted the engage, educate, execute, and evaluate improvement concepts. Every stroke alert (SA) event is evaluated. Using a rapid improvement process in real-time, the team debriefs to identify learning opportunities (LO) for each event. The nurse’s involvement in the team debriefing process increased staff proficiency and engagement in the SA process. Each LO is translated to new training, coaching, and workflow modification. The ED team regularly assesses workflows and identifies unintended consequences. Finally, The SA team is recognized for their excellent practice. Results: From January 2020 to June 2022, we continue to meet DTN for less than 30 minutes at 89%. Staff engagement led to process changes including a new targeted SA workflow, increase recognition of posterior strokes in triage, reduced SA response time on walk-in patients, and increase compliance in post-thrombolytic assessment. Since the start of the project in January 2022 the Tenecteplase treatment rate is at 2.9% of acute ischemic stroke patients based on the number of stroke alerts. The bleed rate is at 4.2%. Conclusions: The ED SA team learned that transparency and staff involvement provide continued engagement, improved team dynamics, and a culture of continuous improvement. Thus, sustaining door-to-needle times, improving clinical outcomes and quality of care.