Problem statement and background: Early initiation of thrombolysis is the key factor to improving quality of life in ischemic stroke patients. The facility has an internal goal of 100 percent. DTN < 60 minutes was not being met. The purpose of this project was to streamline the DTN time using the Lean Rapid Improvement Process (RI).
Methods: In January 2013, a Lean Transformation RI team was created and involved a collaboration of key frontline stakeholders. The team observed the current procedure, created an event map that detailed each step, and non-value added steps. The current process was analyzed to identify barriers to flow, and excessive lead times. The inter-disciplinary team clearly defined all stakeholder roles and streamlined process was created.
Results: The average DTN time in 2012 was 76 minutes with 40 percent less than 60 minutes (n=71). After the RI event, average minutes decreased from 68 minutes (n=39) in 2013 to 48 minutes (n=60) in 2014 and 39 minutes (n=49) through June 2015. Overall, the percentage increased from 54 percent in 2013, to 84 percent in 2014 and 94 percent in 2015. The greatest change in performance improvement was seen after the initiation of the RI process in 2015. This resulted in an average improvement of 36 minutes and 54% from 2012 to 2015. The fastest DTN time was 19 minutes.
Conclusion: The inter-disciplinary team collaborated to streamline the DTN process resulting in a significant reduction in time to tPA administration. The new process rapidly expedited the stroke alert procedure by facilitating timely movement, assessment and treatment of stroke victims. The streamlined procedure will be continued with the goal of ensuring that our performance continues to exceed the Target Stroke Phase II initiative of DTN < 45 minutes. The outcome of this improvement is optimizing the quality of life, patient satisfaction and enhanced team engagement.