Abstract WP200: "Stroke on the Fast Track: Advancing Door-to-Puncture Through EMS Optimization"

Background: Acute ischemic stroke is a leading cause of morbidity and mortality worldwide. Mechanical thrombectomy has emerged as the gold standard for treatment in patients with large vessel occlusion, offering potential for significant neurological recovery. Timely reperfusion therapy is critical for brain tissue preservation, with shorter door-to-puncture times linked to better survival, reduced disability, and improved quality of life. Purpose: This quality improvement initiative aimed to achieve the American Heart Association’s door-to-puncture time of ≤60 minutes in ≥85% of eligible patients, regardless of arrival mode. Methods: An interdisciplinary team spearheaded this initiative, emphasizing enhanced communication and collaboration across care settings. Through a comprehensive review of existing processes, clinical practices, and data, the team pinpointed opportunities for optimization. Key interventions included strengthening prehospital EMS communication by implementing an escalation notification system based on the S-LAMS score, designating a dedicated emergency department room near the CT scanner for rapid neurological assessment of S-LAMS-positive patients, and prioritizing ongoing EMS education paired with a standardized feedback form for case-specific reviews to support triage accuracy and foster continuous quality improvement. Results: The initiative significantly improved stroke care, increasing the percentage of patients meeting the American Heart Association’s ≤60-minute door-to-puncture target by 106%. From January to May 2025, 33% of patients achieved the goal, with monthly rates rising from 0% in January and February to 40%, 50%, and 60% in March, April, and May, respectively, reflecting enhanced coordination, workflow efficiency, and sustained improvements in stroke care metrics. Conclusions: This performance improvement initiative demonstrated that interdisciplinary collaboration, targeted communication strategies, and process optimization can significantly enhance stroke care delivery. Strengthening partnerships with EMS and implementing streamlined workflows contributed to improved efficiency and alignment with national time-sensitive goals.