Abstract W P357: Defining Stroke Flow Process in the ED

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Background: Each month in a large community comprehensive stroke program it is common to have 160-180 code stroke activations requiring multiple clinicians responding to this number of strokes. This volume can lead to role confusion, task duplication and additional unnecessary communication hand-offs. Purpose: The scope of this project was to: decrease unintentional care delays by defining and clarifying roles; eliminate task duplications, optimize utilizations of resources; and improve hand-off communication. Additionally, the number of activations was leading to stroke fatigue and inconsistency of team member attending strokes. Methods: Lean methodology was utilized to map out stroke patient throughput from January 2012 to July 2013. To visually illustrate the desired future state, swim lane graphics were developed showing the individual roles and a color coded role delineation chart was created showing specific team member responsibilities. A clip board with a timer was passed from nurse to nurse as a baton heightening 60 minute countdown awareness. The final phase of the project prioritized code stroke activations based on acuity into RED and YELLOW stroke alerts. RED signified a patient as a possible candidate for intervention; the YELLOW has longer symptom onset and is evaluated by a minimal team initially and upgraded if necessary. Results: The ultimate goal was to improve patient throughput and staff efficiency. The door to needle (DTN) time decreased from a mean of 73 minutes to a mean of 55.9 minutes. The DTN time continued to decrease to a mean of 50.8 by end of 2013. The prioritizing of code stroke into RED and YELLOW has demonstrated efficiency in team members’ time with approximately 25% now paged as yellow. Conclusions: Utilizing lean methodology can be lengthy and laborious; even though the project itself was completed the momentum continues to drive process improvement. In 2014 the team initiated EMS going straight to CT and began reviewing door to groin times. The additional process change has further decreased DTN time to 44.7 minutes by June 2014. Fine tuning flow process of patient throughput and role clarification supported management of multiple patients at one time and favors improved patient outcomes.