Implementing lean process improvement methodology significantly reduced door-to-needle times for intravenous tPA in acute ischemic stroke from 60 minutes to 39 minutes (P<0.0001).
Observational (n=219)
Does a streamlined tPA protocol using lean process improvement reduce door-to-needle times in patients with acute ischemic stroke?
Implementing lean process improvement methodology significantly reduces door-to-needle times for tPA administration in acute ischemic stroke without compromising safety.
Tasa de eventos absoluta: 39% vs 60%
valor p: p=<0.0001
BACKGROUND AND PURPOSE: Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol. METHODS: In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the tPA-treated patients in the "pre-VSA" epoch with the "post-VSA" epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. RESULTS: The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 minutes versus 39 minutes (P<0.0001) and 52% versus 78% (P<0.0001), respectively, with no change in symptomatic hemorrhage rate. CONCLUSIONS: Lean process improvement methodology can expedite time-dependent stroke care without compromising safety.
Ford et al. (Fri,) conducted a observational in acute ischemic stroke (n=219). Lean process improvement methodology (post-VSA protocol) vs. Pre-VSA protocol was evaluated on door-to-needle times (minutes) (p=<0.0001). Implementing lean process improvement methodology significantly reduced door-to-needle times for intravenous tPA in acute ischemic stroke from 60 minutes to 39 minutes (P<0.0001).