Abstract WP74: Organized System of Care Improves Door to Needle Times in Rural Montana

Abstract

Early reperfusion is critical to improved outcomes from acute stroke, with door-to-CT times < 25 min and door-to-needle times < 60 min as key performance metrics. These may be difficult to achieve in critical access hospitals (CAHs) due to low volumes, longer EMS transport, delays to provider response, challenges in obtaining rapid CT, and lack of access to neurology consultation. Each of these represent appropriate targets for performance improvement efforts. Methods: In 2022, The Montana Stroke Initiative began a quality improvement project to improve door-to-CT and door-to-needle times for acute stroke in rural Montana (MT) with the following objectives: 1. Engage more CAHs in the stroke registry. 2. Initiate monthly clinical learning collaboratives to share stroke data and best practices in reducing door-to-CT times. 3. Create statewide stroke order-sets. 4. Involve stroke coordinators and physicians from MT’s certified stroke centers in providing education on the order-sets, NIHSS, and the importance of data abstraction for quality improvement. The Montana Department of Health and Human Services collects statewide stroke data using the Get With The Guidelines®-Stroke registry. For this analysis, all CAH acute stroke patients evaluated for thrombolytic therapy in 2021 and 2022-23 were included. These cohorts were compared to total number of patients and the primary outcome measures of door-to-CT time <25 min and door-to-needle time < 60 min. Registry participation doubled from 12 hospitals in 2021 to 24 in 2022-23. The total number of suspected stroke patients increased from 126 patients in 2021 to 269 patients in 2022-23. Mean Door-to-CT time decreased from 56 min to 39 min (p=0.004), with Door-to-CT times 25 min increasing from 31.7% to 50.6% (p<0.001). Thrombolytic therapy was given to a total of 10 patients in 2021 and 36 patients in 2022-23. Mean Door-to-Needle time decreased from 118 min to 77 min (p=0.026), with Door-to-Needle times 60 min increasing from 10.0% to 33.3% (p=0.24).In conclusion, an organized effort to improve door-to-CT processes for suspected stroke patients, including sharing data and best practices, and providing focused education, has resulted in more patients receiving lytic therapy in the recommended time of < 60 minutes.