Abstract WMP26: Performance Improvement During A Pandemic: Implementing Weekly Case Review To Decrease Door-to-CT And Door-to-Needle Times For Code Stroke Patients

Abstract

Background and Purpose: When reviewing Code Stroke workflow data early in the COVID pandemic, a delay in obtaining CT brain imaging for stroke patients was identified. This study was aimed at improving Door-to-CT and Door-to-IVtPA bolus times by developing an Emergency Department (ED) led process improvement (PI) team to identify and track root causes for delays, provide feedback after fallouts, and recognize care teams after successful cases. Our primary goal was to demonstrate improved trends for performance metrics utilizing a novel method of process improvement, data collection, analysis, and dissemination. Methods: All ED patients activated as a Code Stroke were included in a weekly workflow review conducted by the PI team. Patients with a Door-to-CT of > 20 minutes were analyzed by the team via an in-depth chart review to identify the root cause of the delay. Specific metrics analyzed included Door-to-CT times and Door-to-IVtPA bolus times, along with the percentage of cases that met process metric time goals. Implementation of the weekly review began September 31, 2020, with the pre-implementation period corresponding to the prior nine months and the post-implementation period being the ensuing nine months. Metrics were analyzed using a control chart based on monthly metric averages, standard deviations (SD), and both an upper and lower control limit defined as 1 sigma level of variability from the average. Results: The average Door-to-CT time pre-implementation was 30.6 minutes versus 22.8 minutes post-implementation, with a percentage goal within 20 minutes pre- and post-implementation of 47% and 66%.The average Door-to-IVtPA Bolus time pre-implementation was 40.1 minutes versus 31.5 minutes post-implementation, with a percentage goal <30 minutes pre and post-implementation of 42% and 56%.The SD for Door-to-CT average improved from 4.81 to 3.76, while the Door-to-IVtPA Bolus average SD decreased from 9.26 to 8.53. Conclusion: Reviewing identification, activation, and treatment times for all ED Code Stroke patients during the COVID pandemic was associated with significantly reduced imaging and treatment times.