Abstract WP201: Lean, Fast, and Focused: Standardizing Stroke Activation to Optimize Door-to-Needle and Door-in-Door-Out Time

Background: Quick identification and evaluation of patients presenting with stroke symptoms are essential for rapid thrombolysis and identification if patients need transfer for emergent thrombectomy. At a large, urban primary stroke center, inconsistencies in the stroke activation process in the emergency department were leading to delays in stroke identification and treatment. The aim of this initiative was to develop a patient-centered process utilizing standard work and clear communication to achieve consistent outcomes, specifically targeting a reduction in median door-to-needle (DTN) and door-in-door-out (DIDO) times. Methods: A multidisciplinary team developed a new, streamlined protocol using lean methodology, gap analysis, and process mapping. The protocol was developed for patients presenting with BE-FAST+ symptoms within 24 hours. The interventions included a “pit stop” for rapid evaluation and immediate physician assessment, utilization of a stroke evaluation triage order panel, direct transport to imaging for CT and CTA, rapid reads of scans, clear role assignments, and elimination of low priority tasks. All stroke alert cases were evaluated for 12 months pre-intervention (December 18, 2022 – December 17, 2023) and 12 months post-intervention (December 18, 2023 – December 17, 2024). Results: During the study period, there were 360 stroke alerts pre-intervention and 354 post-intervention. The median DTN time significantly decreased from 67 minutes (n=10, range: 33-142 mins) to 40 minutes (n=9, range: 22-108 mins, p=0.045). The median DIDO time decreased from 249 minutes (n=5, range: 53-441 mins) to 106 minutes (n=21, range: 77-243 mins, p=0.047). Additionally, improvements were observed in median door to stroke alert time (17 to 12 mins), median stroke alert to CT start (9 to 7 mins), median CT complete to preliminary results (15 to 8 mins), stroke evaluation order panel utilization (75.4% to 78.1%), and the rate of confirmed stroke diagnosis (36.2% to 42.9%). Conclusion: Implementing a streamlined, standardized workflow significantly reduced both DTN and DIDO times, demonstrating the effectiveness of this approach in improving acute stroke care processes and patient outcomes.