Abstract
Background: The American Heart/ American Stroke Association (AHA/ASA) established national 60 and 45-minute alteplase treatment targets ensure timely administration of alteplase in patients with acute ischemic stroke (AIS). To challenge the 21 facilities of our integrated health system, our organization established a treatment target of 30-minutes or less. To raise the bar further, our local facility set a treatment target of 25-minutes or less. Purpose: To streamline and standardize rapid assessment and treatment for AIS patients receiving alteplase in 25-minutes or less at a CSC. Methods: Baseline data and process timeline were reviewed, and the workflow was evaluated using real-time observations conducted by front-line staff. Staff, physicians, and former patients involved in cases that met the 30-minute target were interviewed. Several Plan-Do-Study-Act cycles were performed. An interdisciplinary subcommittee meets weekly to review cases for compliance and evaluation for process sustainability. An in-depth review is conducted for all cases outside the 25-minute treatment target. AHA/ASA exclusion criteria are allowed. Results: Baseline data was reviewed yielding 18% compliance to the target of 25-minute or less (3/16). Changes were implemented in April 2018. Between April 2018 and July 2019 of the 107 cases treated, 55% of cases were within 25-minutes, 81% within 30-minutes, 85% with 45-minutes, and 95% in 60-minutes. Keys to decreasing times were use of timer, a designated timekeeper, announcement of time increments, and revisions of the process. Data and other graphics were posted in the Stroke Alert vestibule as a visual aid for staff. Collaboration between departments was integral in driving change. Conclusion: Challenging national and organizational treatment targets and revising workflows were effective ways to sustain alteplase treatments times of 25-minutes or less.
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