Abstract WMP44: Feasibility Of Monitoring Door-in-door-out Across A Fourteen Hospital Telemedicine Supported Stroke System Of Care

Abstract

Background: Door-In-Door-Out (DIDO) times are crucial to help improve outcomes for patients presenting to Primary Stroke Centers (PSCs) needing urgent endovascular therapy. However, DIDO is often a difficult measure to track and improve due to relatively low volumes at a single stroke program. Healthcare networks hold a significant advantage through standardization of processes which then allow for aggregate data collection. Methods: We designed a system that went live 1/2021 using PowerBI™ and Microsoft Suite™ products to monitor DIDO across 13 PSCs. Data queries from existing centralized stroke data were modeled together with internal transport team data into one report resulting in an interactive chart used to track DIDO and its related performance measures including: door to transfer center contact time (DTCC), door to ambulance arrival time (DAA), ambulance arrival to ambulance departure Time (AAAD) and reasons for delayed transfer. Data was analyzed using Wilcoxon Rank Sum test. Results: Metrics were assessed pre (1/1/2021-3/31/2021) and post (4/1/2021-12/31/2021) implementation of a dashboard guided process improvement. There were 32 transfers pre vs. 86 post-implementation. Median DIDO improved: (Pre: 120 min {IQR:82-146} vs. post: 86 min {IQR: 62-108} p=0.004). Other sub-metrics of DIDO all improved: Median DTCC (Pre: 55 min {IQR:32-76} vs. post: 38 min {IQR: 22-53} p=0.032); median DAA (Pre: 89 min {IQR:68-126} vs. post: 67 min {IQR: 43-84} p=0.041). There was a trend to improvement for the median AAAD: (Pre: 24 min {IQR:12-36} vs. post: 19 min {IQR: 10-24} p=0.054). Conclusion: Relatively low volume but high-risk events like DIDO transfers can be improved by leveraging the use of modern data display and analysis software solutions that process the collective data aggregate generated from standardized workflows across a health care network.