Abstract
Introduction: Effective therapy of acute ischemic stroke (AIS) is time dependent, and outcomes are influenced by the organizational capacity of each healthcare delivery system to successfully implement stroke treatment protocols that include time targets. Objective: Analyses of both workflow process and individual stroke care team structure and function will identify critical system characteristics associated with the delivery of thrombolytic therapy according to treatment guidelines in a real-world health care system. Methods: We performed a mixed method analysis (integration of medical outcomes, workflow process analysis and team personnel structure/function mapping) in 11 acute stroke care sites within a single health care system. Individual facility characteristics, variation of treatment delivery, and acute stroke care critical paths were evaluated at each care site. Formal and informal stroke care teams were mapped using network analytic software. Results: Based on these data, a benchmark hospital was identified. This site had 422 admissions for ischemic stroke in 2012, with the following median transition times for thrombolysis candidates: door to radiology (13.4 minutes), turnaround time for reporting lab results (40 minutes), time from order to scan result (20 minutes), and time from order to infusion (22 minutes). Network analysis of the team members revealed a robust, integrated team with high scores for centrality and density. The structure of the network was strongest in the workflow areas with the best performance. Conclusion: Health care delivery systems can access basic data on stroke management and health outcomes; however, these data sources are incomplete with respect to the complex interactions of personnel and processes associated with effective acute stroke care. A mixed method model of real-world stroke care teams provides new insights into the key system-level solutions for the rapid delivery of thrombolytic therapy.
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