Abstract WP26: Multidisciplinary Case Reviews Reduce "Door-to" Times

Abstract

Background: Rapid reperfusion is critical for positive outcomes in stroke patients. To improve patient outcomes, the organization reduced program goals for all door-to metrics. To reach the aggressive new goals, a door-to task force led by the Stroke Program Coordinator was created. The multidisciplinary task force meets monthly and consists of members from Pre-Hospital, ED, Stroke, CT, and Neurointerventional Radiology (NIR). Interventions: Door-to data is shared monthly and case reviews on all door-to fall-outs are performed. The task force reviews door-to-CT, door-to-thrombolytics, and door-to-puncture metrics. An RCA is conducted on each case that exceeds our time goals looking for areas for improvement. Each case is evaluated from initial EMS contact through initiation of treatment; with all members of the multidisciplinary team participating. A trend in prolonged door-to-puncture was seen; so further investigation into the causes for the delays was done by the task force. This led to several improvement initiatives that addressed each of the delays. Education was completed for ED, CT, and NIR staff on the significance of a rapid initial evaluation and transport to NIR. An outside hospital (OSH) transfer notification process was created for OSH transfers eligible for thrombectomy. A direct-to-angio process was also developed to allow transport from CT to the NIR suite without stopping in an ED room. Results: The combination of these initiatives had a positive impact on door-to-puncture times. When comparing 2021 data to year-to-date 2022 post-implementation data, a reduction in door-to-puncture has been seen. Median time for door-to-puncture in 2021 was 60 minutes. This time has reduced to 48 minutes for the January through June 2022 timeframe. Conclusion: A multidisciplinary door-to task force reduces door-to-puncture times by keeping constant focus on door-to metrics and by creating a shared accountability for the process. With the door-to task force, real-time case reviews can be completed to allow for rapid identification of areas of opportunities and initiation of process improvement initiatives to reduce door-to times.