Abstract WP290: A Resident-Driven Intervention to Decrease Door-to-Needle Time and Increase Resident Satisfaction in a Resource-Limited Setting

Abstract

Introduction: Neurology residents are often the first-line responders to emergency department (ED) stroke codes, however their role in initiating stroke systems changes is not well established. At a large, resource-limited public hospital, neurology residents developed a protocol for acute stroke codes focused on improved interdisciplinary communication. Methods: Process mapping was used to identify current state deficiencies. Poor communication between neurology residents and ED physicians, nurses, and radiology techs and role redundancy were identified as core deficiencies. Ideal and future state maps were used to create a stroke code workflow diagram (the “protocol”). Changes included assigning specific responsibilities to each team member, and forcing interdisciplinary communication at specific points in the process (i.e. ED physician calls tech when patient goes to CT). The protocol was implemented in May 2016. Median door-to-needle (DTN) times were compared in the pre-intervention (January 1, 2014 - April 30, 2016) and post-intervention (May 1, 2016 - June 15, 2017) periods using non-parametric tests. Resident satisfaction with communication during stroke codes was measured using pre- and post-intervention surveys; responses were compared with t-test. Results: A total of 66 patients received tPA, 20 (30%) in the post-intervention period. Baseline demographics and NIHSS did not differ in the pre- and post-intervention periods, however median DTN decreased (58 vs. 40 min, p=0.02) and proportion of DTN≤45 minutes doubled (30% vs. 60%, p=0.03) in the post-intervention period. Twenty-three residents (79%) completed pre-intervention surveys; 19 residents (64%) completed post-intervention surveys. Resident satisfaction was greater in the post-intervention period with respect to stroke team communication (2.8 vs. 3.6, p=0.01), understanding multidisciplinary roles (3.8 vs. 4.3, p=0.03), and interaction between team members (3.2 vs. 3.8, p=0.03) measured using a five-point scale (higher being better). Conclusion: In a resource-limited setting, neurology residents are capable of implementing acute stroke workflow changes using basic process improvement methods that have a measurable impact on DTN and resident satisfaction.