Abstract TP044: Improving Time to Treatment for Acute Ischemic Stroke Patients

Authors: Victoria Kinder, BA; Theresa Scotto, MSN, RN, SCRN; Courtney Dowling, MSHA, RN, CCRN; Fan Z. Caprio, MD; Sarah Cummins, RN Background: The goal of this project was to increase the percentage of eligible patients receiving TNK within 30 mins of arrival to the Emergency Department (ED). The scope of this project included patients ≥ 18 years old arriving at the ED as a walk-in with positive BEFAST and eligible for TNK. Methods: The Define, Measure, Analyze, Improve, Control (DMAIC) methodology was utilized throughout this project. The project team first analyzed historical data for door to stroke code activation (goal ≤ 3 minutes) and arrival to CT start time (goal ≤ 10 minutes). The team created a new process for walk-in stroke codes that mimicked EMS stroke codes (Figure 1). Namely, bedside registration instead of waiting room registration and direct to CT (IV, vitals, blood sugar, NIHSS all completed after plain brain) were implemented. The team also promoted stroke code cancellations when stroke work-up was not clinically indicated. If the patient was eligible for TNK, then it was administered during the pause between imaging while waiting for contrast to load. For EMS activations, the process was revisited, and staff were educated to pre-activate a stroke code for EMS arrivals with a positive stroke screen in the field. A second pivot nurse (first person that meets the patient) was implemented to expedite the triaging process. To optimize the success of this project, the project team met every two weeks to review feedback for various steps implemented on the new process map. Results: This project significantly increased the percentage of patients receiving TNK within 30 minutes of arriving at the ED (Figure 2). Conclusions: Creating a direct to CT process for walk-in stroke code patients greatly increased the percentage of eligible patients receiving TNK within 30 minutes. Now in the control phrase, Bi-Monthly meetings remain scheduled with the interdisciplinary teams to ensure the sustainment of changes made to this process.