Background and Purpose: The Joint Commission recommendation is to meet door-to-needle (DTN) times of less than 60 minutes in 50% of tPA recipients. Lake Cumberland Regional Hospital is a certified primary stroke center by The Joint Commission and has strived to develop a process that drives DTN times to less than 60 minutes for acute ischemic stroke patients being treated with tissue plasminogen activator (tPA). Baseline data from 2014 showed tPA compliance was 27% (n=15). In 2015, pre-implementation tPA compliance was 0% (n=3).
Methods: Guided by a process map outlining time frames for all steps in the tPA administration process, findings were utilized to identify barriers, inefficiencies, and solutions. An educational program was developed and centered on identified barriers. Educational sessions were completed for all emergency department staff. DTN times were analyzed before and after implementation of educational program. A timekeeper role was implemented in the emergency department to increase awareness during cases of tPA administration.
Results: 100% of Emergency Department staff was educated on process map, Joint Commission recommendations, and role of timekeeper. Since completion of educational sessions and implementation of timekeeper role, Lake Cumberland Regional Hospital has met The Joint Commission DTN recommendation in 78% (n=9) of patients treated with tPA. As of August 11th, overall DTN compliance for 2015 at Lake Cumberland Regional Hospital was 54%.
Conclusions: Average DTN treatment times were decreased and compliance with The Joint Commission standard of meeting DTN times of less than 60 minutes in 50% of tPA cases was improved. For continued identification of performance improvement initiatives, debriefings are conducted after each tPA case with all staff involved to discuss strengths, barriers, and opportunities for improvement.