Abstract WP22: Time Is Brain: Improving Door To Thrombolytic Times Through A Multidisciplinary Approach

Abstract

Background: Research supports stroke as the 5th leading cause of death in the United States and the leading cause of long term disability. As a primary stroke center, it is necessary to establish and meet stroke standards of care. The American Heart Association Target: Stroke Phase III initiative focuses on timely intravenous thrombolytic administration. A community hospital primary stroke center encountered challenges with meeting established goal times. To improve rapid treatment times and patient outcomes, a multidisciplinary team collaborated to improve workflow. Purpose: To decrease door to thrombolytic therapy times in eligible ischemic stroke patients. Methods: As a result of retrospective chart audit findings from January through December 2020, a new workflow process was developed, which included: • Education with EMS regarding pre-notification • Relocating a weighted, zeroed patient bed near the ambulance entrance to obtain an accurate weight • Patient going directly to the computed tomography scanner accompanied by the entire stroke team • Earlier activation of the Tele stroke neurologist • Relocating the Tele stroke monitor to the computed tomography scanner area for immediate assessment • Pharmacist at bedside to assist with medication preparation • Real time feedback and data sharing Results: In 2021, the new work flow resulted in a 48% time reduction in door to IV thrombolytic administration times. Median door to IV thrombolytic times decreased from 58 minutes to 28 minutes with 75 % of the population receiving IV thrombolytic therapy in 30 minutes or less. Conclusions: A redesigned workflow process, along with a multidisciplinary team approach led to significantly decreased door to thrombolytic therapy times. Key success factors included a consistent team approach, feedback, education, and data sharing for continual improvement.