Abstract WP304: Leveraging the Power of a System A Team-based Approach to Improving Door-to-alteplase Administration

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Background/Purpose: As stroke remains the leading cause of disability, hospitals are challenged to streamline processes that deliver alteplase promptly. A large Midwestern healthcare system (2 comprehensive and 8 primary stroke centers) committed to expand the stroke team approach beyond the walls of individual hospitals to a system stroke team to improve alteplase administration rates and times. A team-based approach is 1 of 11 Target Stroke best practice strategies used to enhance treatment rates and reduce administration times. The team-based approach included review/standardization of processes, clinical outcomes review, and proposals for improvement. Examples of initiatives included EMS partnership, development of standardized stroke orders, direct-to-CT protocol, timers to signal time critical events, and debriefing/feedback tools.Method: A retrospective system data analysis was performed on all patients presenting to an emergency room with acute stroke symptoms who received alteplase between 2012 and 2015. The specific data elements scrutinized were alteplase treatment rates and administration times. Additionally, with the introduction of Target Stroke Phase II in 2014 progression towards those goals between January, 2014 and June, 2016 was examined.Results: Statistical analysis of treatment rates for acute ischemic stroke confirmed an increasing trend in the probability of receiving alteplase over time (6.3% in 2012 vs 11.2% in 2015, p<0.0001). Alteplase administration times revealed an average of 5.3 minute reductions per year over time (p<0.0007). Progress toward Target Stroke phase II goals demonstrated an increasing trend in alteplase administration rates for less than 60 minutes (38.5% in 2014 vs 67% in 2016, p<.001) and for less than 45 minutes (11% in 2014 vs 30% in 2016, p<.001).Conclusion: This study substantiated that utilizing a team-based approach at the system level yielded positive results. It has inspired and challenged each hospital’s stroke team to embrace the team approach and implement best practices and improve the administration rates and times for alteplase.

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