Background: Tissue plasminogen activator (tPA) remains the only FDA approved drug treatment for acute ischemic stroke, and research continues to provide evidence that the earlier treatment brings better outcomes. In 2013, the stroke team at this Comprehensive Stroke Center was treating 24% of patients with tPA in less than 60 minutes and 8% in less than 45 minutes. In order to meet the increasingly challenging DTN benchmarks, the program leadership recognized the need to re-invigorate the acute stroke process and to address reasons for delay: staff disengagement, lack of knowledge of stroke core measures, and little incentive to meet the benchmark.
Hypothesis: Consistent presence by a stroke coordinator during acute stroke events results in improved outcomes through identification of barriers, focused recognition of nurses and providers, competitive use of data, and facilitation of relevant team education.
Methods: A report card was developed for providers, identifying their average DTN, and personal best and worst times. A stacked bar graph showed the critical time frames for each case. Staff involved with good DTN times were promptly recognized publicly, via same-day group email and received ID badge holders that read “Bustin’ clots faster than you can say tPA”. The stroke coordinator and a provider “champion” developed mock brain attack scenarios utilizing simulation technology which are now available to EMS, ED and ICU nurses and providers, CT staff, and neuroscience residents. The education focused on a standardized process for the first 5 minutes.
Results: In 2014, tPA was administered 66% of the time under 60 minutes- a 57% improvement. In 2015, 94% under 60 minutes and 69% under 45 minutes. In addition, 5/16 (31%) were under 20 minutes, the fastest being 9 minutes. All patients who received tPA in 20 minutes or less were back to baseline by discharge.
Conclusion: Stroke coordinator’s consistent presence during acute strokes promotes: 1) healthy competition as staff become aware of the data and benchmark goals, 2)timely feedback, and 3) relevant hands-on education to appropriate team members with the ultimate outcome being significantly reduced DTN times which leads to better patient outcomes.