Abstract WP31: Driving Down Door To Needle Time: ED Stroke Leadership's Commitment To Continuous Improvement

Abstract

Background: In March 2019, our 126 bed community hospital received Primary Stroke Center Certification. The Emergency Department (ED) Stroke Leadership Team was tasked with the responsibility of identifying opportunities for process improvement and implementing changes within the ED. Purpose: The purpose of this poster is to illustrate the ED Stroke Leadership Team’s commitment to continuous improvement ultimately reducing EMS Door to Needle time. Method: Data was obtained through retrospective case review of patients who arrived via EMS and received IV thrombolysis for acute ischemic stroke in the ED, between April 2019 and June 2022. Process improvement data was reviewed monthly and interventions were implemented at various intervals using the Plan-Do-Check-Act (PDCA) method. Some early interventions included but were not limited to: EMS pre-notification, a broadcasted stroke alert for all ED staff including pharmacy and CT, and the creation of an EMS direct to CT process. January 2022, the ED Stroke Leadership Team began their 4 th cycle of the PDCA. In addition to changing the IV thrombolytic from alteplase to tenecteplase, the team took the opportunity to make additional changes to the process and provided education of the stroke protocols and measures to the staff. Results: The ED began receiving stroke patients via EMS in April 2019. At the end of 2019 a total of 13 stroke patients arrived via EMS with 5 patients receiving IV thrombolytic therapy with a median Door to Needle baseline of 51 minutes. In 2020 & 2021 EMS stroke pre-notifications increased to 30 and 72 patients respectively but the IV thrombolytic was given to a two year combined total of 9 patients with a median Door to Needle time of 41 minutes. January 2022 we began to see a rise in the volume of stroke patients. As of June 2022, EMS delivered 53 patients in which 9 received IV tenecteplase with a median Door to Needle time of 28 minutes. These incremental process improvements represent a 45% decrease in EMS Door to Needle over the last 3 years. Conclusions: In conclusion, the ED Stroke Leadership Team’s commitment to continuous improvement has been the driving factor in the reduction of the EMS Door to Needle time.