Background and Purpose: Our 921 bed community hospital was awarded Comprehensive Stroke Center status in 2012 and has continued its pursuit for excellence achieving Target: Stroke Honor Roll Elite Plus designation for the past two years. As a Comprehensive Stroke Center our goal is to provide excellent care to the acute ischemic stroke population while decreasing door to Alteplase times. Achieving a door to Alteplase time of less than forty-five minutes in 50% of cases was a significant improvement in our target treatment time; however our team set an internal goal of 30 minutes.
Method: Our stroke leader team conducted a microscopic review of each phase of our Emergency Department stroke response process known as “Code Purple” to identify opportunities to reduce time. Partnering with Neuro Emergencies and Telemedicine leadership, Emergency Medical Services (EMS), Emergency Department nursing leadership, and Pharmacy, process improvement changes implemented including the addition of an emergency department stroke champion and refinement of our administration processes.
Results: Program enhancements were initiated in September of 2015. Results as of June 2016 demonstrated that our strategies have shown positive results to date. Our average time from door to Alteplase has decreased from an average of 41 minutes to 32 minutes, patient arrival to brain image complete has decreased from an average of 19 minutes to
14 minutes and brain image read to drug administration has decreased from an average of 12 minutes to 10 minutes.
Conclusion: Establishing a multi-disciplinary stroke leader team to identify areas for improvement, create and implement goal-supporting processes, and evaluate results has led to the time reduction in major time sensitive measures. These trends are positively reflected in our monthly dashboards. More importantly, we have accomplished the decrease in Alteplase administration times while maintaining the complication rate post-Alteplase below national average.