Abstract WP401: Code Fast: a Quality Improvement Initiated to Reduce Door to Needle Times

Abstract

Introduction: Rapid delivery of intravenous t-PA in qualifying patients leads to better clinical outcomes. The American Heart Association has reduced target door to needle (DTN) times from 60 to 45 minutes in the hopes of continued process improvements across institutions. We thus started a quality improvement project called CODE FAST in order to reduce DTN times at our institution. These results were recently reported and published. Materials and Methods: We retrospectively reviewed data from our internally maintained database of patients treated with intravenous t-PA prior to and after implementation of the CODE FAST protocol. We assessed demographic information, time of day and times of arrival to first image and delivery of t-PA in patients from February 2014- February 2015. Outcomes were assessed based on discharge to home. Univariate analysis was performed to assess for improvement in DTN times prior to and after implementation of the protocol. We will present the latest data from February 2014- January 2016. Results: We previously reported 93 patients (41 pre-CODE FAST and 52 post-CODE FAST) received IV t-PA during the study period. We showed a substantial reduction in door to imaging time from a median of 16 to 8 minutes (p<0.0001) and DTN time with a reduction in the median from 62 to 25 minutes (p<0.0001). In logistic regression modelling, there was a trend towards more discharges to home in patients treated during the CODE FAST era. From March 2015-July 2015 an additional 57 patients have received t-PA under the CODE FAST protocol. The median door DTN remains 27 minutes. We will report further analysis comparing day and night time analysis and further strategies to further reduce DTN times. Conclusions: We present a quality improvement project that continues to be an overwhelmingly success in reducing DTN to less than 30 minutes. Further opportunies exist to reduce time further and improve discharge outcomes.