Introduction: In 2010, the Champlain Regional Stroke Network (CRSN) identified door-to-needle (DTN) time performance as a strategic goal, as the Regional Stroke Centre (RSC) was not consistently meeting the Best Practice Standard DTN time of ≤60minutes. The CRSN began to track DTN performance in real-time, which helped identify bottlenecks that prevented the delivery of tPA within 60 minutes. The Recognition Program (RP) started at the RSC, with the plan to apply at other stroke-centers in our region.
Hypothesis: We assessed the hypothesis that by creating a collaborative RP, DTN performance would improve.
Methods: The CRSN collaborated with the RSC, Regional Paramedic Program for Eastern Ontario (RPPEO), and Ottawa Stroke Program (OSP), to develop the RP as an incentive to improve thrombolysis DTN times. The RP awards a letter and a pin to all team members involved in stroke codes where tPA is administered in ≤40minutes (e.g. RNs, CT-techs, Paramedics, Orderlies, Physicians, Residents). Performance improved significantly over the first year, which resulted in the elimination of the 40 minute pin and the introduction of time-specific pins for 35, 30, 25, 20 and 15 minutes. We also launched a Quality Pin to recognize staff for providing excellent stroke patient care, that might not involve tPA administration. DTN times are reported quarterly to review performance and ensure consistency over time.
Results: Over 4 years, the RSC has had steady performance and improved median tPA DTN time from 94 minutes to 40.5 minutes. There have been over 110 cases where pins have been distributed (DTN≤40minutes) and over 50 Quality Pins awarded. The telestroke centres in the Champlain region have adopted the RP and continue to see improvements in their DTN performance.
Conclusion: The RP is a collaborative effort that can be applied to various projects to drive performance, as evidenced by our introduction of stroke Quality Pins for staff that go above and beyond providing stroke care.