Abstract WP376: Using the Plan-Do-Study-Act Model to Improve IV TPA Administration Times

Abstract

Background: Current guidelines for management of acute ischemic stroke include distinct recommendations regarding IV Tissue Plasminogen Activator (TPA) administration times. While 75% of all strokes are ischemic, over 70% of patients are treated after the 3 hour window, placing them at an increased risk for stroke complications. From FY 2014 to FY 2015, Baptist Health System Emergency Departments (ED) had proven that the implementation of the Plan-Do-Study-Act (PDSA) Performance Improvement Model can significantly improve IV TPA Administration Times. Purpose: The purpose of this poster is to describe the use of the Plan-Do-Study-Act Model in improving IV TPA Administration times within Baptist Health System Emergency Departments. Methods: Emergency Departments (Physician Champions, Directors, and Nursing staff) collaborated to standardize processes using lean methodology. Actions taken to improve IV TPA administration times through use of the PDSA include analyzing all TPA fallouts, reporting monthly findings at the regional ED service line (nursing), and submitting findings to the Stroke Coordinator, CNO, and ED Physician Quality Director for follow-up. In addition to the previously used processes of stroke alert notification and evaluating the patient at the door, TPA administration would no longer be held if there was a delay in the telemedicine response. If the ED Physician determined that the patient was a candidate for TPA therapy, the order would be given to administer TPA and the ED Physician would be able to cancel the telemedicine consult if the TPA was administered before reaching the neurologist. The ED Physician would then document the delay in treatment, as appropriate. Results: BHS received the Target Stroke Honor Roll and significantly improved Door to IV TPA therapy within 60 minutes from 53.8% (57/106) in 2013 to 70.5% (62/88) in 2015. Conclusion: In conclusion, BHS showed significant improvement in TPA Administration times through the use of the PDSA Method. Administrative, Physician, Stroke Leadership, and Nursing collaboration with performance improvement items were instrumental in reducing IV TPA administration times in Emergency Departments.