Background and Issues: Despite consistent evidence that functional outcome and quality of life are improved with early administration of IV rt-PA, Kentucky continued to struggle with achieving door-to-needle (D2N) times within 60 minutes of hospital arrival. The Kentucky Stroke Encounter Quality Improvement Project (SEQIP) hospital group voluntarily collaborated to increase treatment rates for rt-PA and decrease D2N times through sharing of data, best practice and adoption of the Target: Stroke 10 Key Best Practice Strategies.
Purpose: The aim of this project was to utilize and share evidence based practice models among certified stroke centers and those pursuing certification in Kentucky to improve rt-PA utilization and D2N times throughout the Commonwealth.
Methods: A statewide quality improvement plan (QI) was developed and targeted toward improvement of stroke patient care with regard to rt-PA administration. Each facility committed to examine data and recruit teams to identify barriers and implement best practice strategies within the confines of available resources. Accountability was achieved with expected sharing of barrier solutions, best practices and ongoing Get With The Guidelines data tracking at face to face meetings.
Results: SEQIP’s participating hospitals achieved improvement compared to 2009 baseline data. Between 2009 and 2014, SEQIP achieved a 25.2% increase in proportion of patients eligible to receive rt-PA (Arrive by 2, Treat by 3 Hours) (n=1387) from 60.4% to 85.7%. Additionally, SEQIP hospitals increased the proportion of eligible patients receiving rt-PA (D2N <60 minutes) from 22.3% to 75.5%, an increase of 53.2%. This resulted in a decrease in median door to needle time of 24 minutes (from 75 to 51 minutes). Statistically significant (p<0.001) improvements occurred in years 2012-2014 compared to baseline in both rt-PA administration and D2N.
Conclusions: With deployment of a strategically targeted action plan and expected accountability, competing hospitals can collaborate on a statewide level. Sharing of best practice across organizations can empower stroke teams to implement the strategies that can be effective within the confines of their resources to achieve their goals.