Abstract TP347: Improving Performance in Target Time Compliance for Acute Stroke using Structured Feedback to Providers

Abstract

Introduction: Time targets for rapid assessment and treatment of acute stroke patients were established in 2005 by the Brain Attack Coalition, including door-to-needle time <60 minutes. At a Primary Stroke Center in Honolulu, HI, we sought to improve compliance with target times by providing structured and meaningful feedback to a multidisciplinary group of acute stroke providers. Hypothesis: We hypothesized that delivering direct, structured feedback to providers would improve compliance with target times for rapid evaluation and treatment of acute stroke patients. Methods: Utilizing a FOCUS-PDCA framework, a quality assurance project was developed to analyze performance measures and identify barriers to timely administration of IV tPA. Onset-to-door, door-to-stroke-code-activation, door-to-CT-onset, door-to-CT-completion, and door-to-lab-result times were monitored for each IV tPA administration at a single Primary Stroke Center during 2009-2012. Through a series of monthly multidisciplinary stroke team meetings, a simple yet comprehensive reporting tool was developed in 2010, utilizing the “traffic light” concept. This feedback mechanism included a case-by-case analysis of compliance to enhance communication among members of the multidisciplinary stroke team. Results: There were 128 stroke code activations with 10 IV tPA administrations in 2009, 147 activations with 21 tPA administrations in 2010, 183 activations with 31 tPA administrations in 2011, and 151 activations with 30 tPA administrations in 2012 year-to-date. During this period, door-to-needle time <60 minutes compliance rates improved from 22.2% in 2009 to 64.7% in 2010 and 53.8% in 2011. In 2012 year-to-date, the compliance rate with the door-to-needle target time has improved to 71.4%. Conclusion: The care of the acute stroke patient is a multidisciplinary endeavor. Feedback to providers involved in the stroke code process is an effective way to improve performance. Developing a simple reporting tool proved an efficient, sustainable way to promote awareness and enhance engagement in performance improvement throughout a multidisciplinary system of care.