Introduction: Reducing Door-to-Needle (DTN) times in the stroke population begins before the patient enters the doors of the hospital. The goal is to administer tPA within 60 minutes of patient arrival but there are often barriers to prevent this from occurring. Literature shows that partnership with Emergency Medical Services (EMS) has been shown to reduce DTN times.
Hypothesis: We assess the hypothesis that partnering with EMS to draw blood prior to arrival and take patients to CT on EMS stretchers will decrease DTN times for acute stroke patients.
Methods: Bon Secours Maryview Medical Center partnered with Portsmouth Fire, Rescue and Emergency Services (PFRES) in an effort to reduce our DTN times and better serve our community. There was a 2 pronged approach: EMS to take patients to CT on their stretchers and EMS will draw blood on acute stroke patients prior to hospital arrival. This was a 60 day trial to begin on April 1, 2015. Discussion began in February 2015 and fifteen PFRES super-users were trained in March. They trained 200 other PFRES partners. Packets were provided with materials necessary for blood draws, as well as instructions. The start date was April 1 with blood being drawn on that date and data tracking beginning. Additional Stroke education was provided to PFRES in May. Feedback was provided via a feedback form and a chart tracked Door to CT times and Door to Labs Received times.
Results: For the three months of April-June, there was a 6-10 minute drop in door to CT times, an average of 53% improvement by utilizing EMS. There was a 7-10 minute drop in door to Lab received times, an average 46% improvement. DTN times for tPA have decreased from an average of 65 minutes the prior 3 months to 50 minutes for April-June, a 23% decrease. Our DTN time in July is 34 minutes, almost half of our totals for January -March.
Conclusion: In conclusion, partnering with EMS on acute stroke patients lowers DTN times and provides better patient care.