Background and Issues: Restoring perfusion to the brain is key to the patient’s recovery and has been at the forefront of stroke treatment and research for the past decade. AHA/ASA has continually challenged acute stroke programs to reduce their IV t-PA door-to-needle (DTN) times. Developing an interdisciplinary team-based approach has helped our stroke program meet, and at times, exceed the door-to-needle time goal for IV t-PA.
Purpose: In response to the AHA and The Joint Commission’s goal, the team re-designed the stroke alert process from the time the patient arrives at the hospital in order to give IV t-PA more expeditiously.
Methods: Critical improvements of the current process were identified such as taking the stable patient straight to the CT scanner from the squad, transferring the patient to a weigh-capable bed from the CT scanner, pre-mixing IV t-PA if the CT is normal, patient eligibility and staff education. An addition of a clinical pharmacist to the stroke alert team has also helped to drive down our DTN times. EMS teams and Aultman ED staff were educated regarding the AHA/ASA goal and the importance of rapid patient triage, prompt initiation of the stroke alert process, coordination of diagnostic evaluation and the administration of t-PA.
Results: In 2013, the average door to needle time was 79.2 minutes. In 2014, the average door to needle time was 68.7 mins. In January of 2015, our team initiated the “Straight to CT” protocol change and the current DTN is 48.3 minutes. Aultman was a recipient of the Target: Stroke Honor Roll award in 2015 and we have maintained our Gold Plus status for Get With The Guidelines performance for 6 consecutive years.
Conclusions: Developing a team approach and identifying opportunities for improvement for care are essential in the success of a stroke program. Effective and efficient stroke care remains Aultman Hospital Stroke Center’s goal and we strive daily for excellence in stroke care.