Background: In 2013 our growing regional stroke referral center was not meeting Target Stroke® best practice recommendations for door to needle times within 60 minutes. A Rapid Improvement Event (RIE) was held to decrease process waste and therefore improve treatment times. Process changes were implemented in January 2014. Twelve months of monitoring identified sustained improvement and evidence that the process could continue to improve therefore a second rapid improvement event was held in January 2015 targeting door to needle times within 45 minutes.
Purpose: The purpose of the process improvement event was to decrease treatment times below 60 minutes targeting 45 minutes.
Methods: The RIE was utilized as the platform to incorporate process improvement principles and evidence based practice in order to elevate the standard of care for patients experiencing ischemic stroke. A multidisciplinary team including pre-hospital and hospital staff met to develop a care model that would impact patients presenting with stroke like symptoms. Lean tools were used to capture waste and bring transparency to the process. A standardized pathway and standard work for each role were developed. Huddles to debrief on successes and barriers from each case were implemented as a way to increase staff engagement and familiarize them with the new process.
Results: Significant improvement was achieved. Median door to needle treatment times decrease from 86 minutes to 49 minutes, a 43% improvement. Treatment within 60 minutes improved from 23% of eligible patient to 67% of eligible patients, this was an improvement of 66%. Treatment within 45 minutes improved from 6% of eligible patients to 45% of eligible patients, this was an improvement of 87%.
Conclusion: Lean principles proved to be an effective tool for improving the thrombolytic delivery process for acute ischemic stroke patients.