Abstract WP17: Best Practices for Optimizing Door-to-Needle Times: Road to Target Stroke Phase III

Abstract

Introduction: The launch of AHA’s Target: Stroke Phase III in 2019 challenged stroke centers to achieve DTN times ≤ 30 min of arrival to ≥ 50% of AIS patients treated with IV thrombolytics. At the time of Phase III launch, we were achieving the DTN ≤ 30 min goal in 43% of patients (median DTN 34 min) at our CSC (> 1300 ischemic stroke discharges/year). Methods: Our stroke team, in collaboration with the ED and other relevant departments, analyzed the stroke alert process and implemented incremental changes (listed below, 1 change per month to allow focus) to improve DTN times. • Vascular neurologist (VN) arriving to ED before EMS for pre-hospital stroke alerts • Assigning specific roles to each stroke team member • Calling out time since arrival every 5 minutes • Minimizing time in ED prior to CT (ie, not changing patient into gown, bypassing EKG) • Premixing alteplase (prior to TNK transition) • Giving IV thrombolytic in CT prior to CTA • Implementing video stroke alerts to allow VN to have virtual presence 24/7 DTN times were collected at launch of Phase III in 2019, and after changes were implemented. Objectives were to improve DTN times from baseline, in order to optimize care and achieve Phase III goals. Results: DTN times improved from a median of 34 min in FY19 to 25 min in FY21, corresponding to an increase in achievement of the Target: Stroke Phase III goal from 43% to 95% (Figure 1). Conclusion: By implementing collaborative and focused interventions, our CSC was able to improve and optimize the workflow of stroke patients receiving IV thrombolytics, allowing us to achieve the rigorous Target: Stroke Phase III goals and optimize patient outcomes.