Background and Purpose: A Primary Stroke Center Emergency Department (ED) identified the need to decrease Door to Needle Time (DNT) for intravenous administration of Alteplase in order to align with stroke standards and provide optimal patient outcomes.
Methods: A systematic review of the data collected since September 2014 demonstrated opportunities for improvement with our current Code Stroke process, consequently delaying DNT. Frontline staff identified a delay in the time from the physician’s order to initiation of Alteplase infusion. Based on the identified communication gaps between the physician and nursing staff, two innovative action plans were developed. An Alteplase Alert was implemented within the existing Code Stroke process. In addition to the facility-wide overhead Code Stroke initially placed upon patient arrival, an internal Alteplase Alert is now initiated within the ED once it is determined the patient is a candidate for Alteplase. Once the Alteplase Alert is initiated the charge nurse, an ED tech, and the designated Code Stroke nurse respond immediately to the patient’s bedside to assist the primary nurse in initiating the tasks associated with Alteplase administration. Secondly, a stroke Alteplase tool was designed to ensure continuity of care and team collaboration.
Results: Data from January 2014 through August 2015 was used to establish the baseline. Prior to implementation, there were 2/17 (11.76%) patients with a DNT less than 60 minutes, with a median time of 84 minutes. After implementation, data from October 2015 through June 2016, demonstrated a decrease in DNT. There were 15/17 (88.23%) patients with DNT less than 60 minutes, with a median time of 51 minutes.
Conclusions: Implementation of the innovative action plans including the Alteplase Alert and Stroke tool helped to accomplish a goal of improved DNT in an efficient and consistent manner. Application of the aforementioned plans led to immediate results. Over the last 10 months, the DNT has sustained a significant improvement.