Abstract W P181: Getting Under Twenty Minutes: Use of the Computed Tomography Direct Protocol to Improve Door to Needle Times

Abstract

Background: Our institution is a comprehensive stroke center in Englewood, Colorado with 55,000 visits to the emergency department (ED) annually. Our 2012 mean door to needle (DTN) time was 41 minutes, with a fastest DTN of 22 minutes. Inspired by the 2012 Finnish study touting mean DTN times of less than 20 minutes, ED leaders developed and implemented the computed tomography (CT) Direct protocol using lean principles to decrease mean door to CT first slice times. Purpose: Use of the CT Direct protocol will decrease DTN times. Methods: The CT Direct protocol details the process of the first few minutes after a stroke alert patient arrives to the facility. The Launch Pad was created and is a designated hallway spot located directly between the emergency medical services (EMS) entrance and CT. Formal signage was installed denoting this special area. The patient arrives to the Launch Pad for rapid registration, brief EMS presentation of history of present illness, medications, and assessment findings. The patient stays on the EMS pram until transport to the CT table and does not enter the ED room until after imaging is completed. An eight week pilot study was performed in 2013 utilizing the CT Direct protocol. This data was compared against information collected during the same period of time in 2012. All stroke alerts brought to the facility via EMS or private car were included in the data sample. Stroke alerts called for patients transferred from an outside hospital were excluded. Results: In the control group (2012) there were 29 stroke alerts called with a door to first slice (DFS) CT mean of 24 minutes and DTN of 43 minutes. This is compared to the CT Direct group (2013) data with 38 stroke alerts called with a mean DFS CT of 20 minutes and DTN of 35 minutes. During the pilot study, the stroke team achieved a record DTN of 17 minutes for one patient, as well as DTN times between 20 and 29 minutes in 3 other patients. Statistical analysis was performed, but failed to demonstrate significance due to small sample size. Conclusions: Use of the CT Direct protocol decreased the DFS CT by 5 minutes and DTN by 8 minutes. Further study is recommended with a sample size of 214.