Abstract TP8: Process Modification to Reduce Door to Puncture Time for Patients With Large Vessel Ischemic Stroke

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Numerous studies have demonstrated the paramount importance of rapid treatment of large vessel occlusion ischemic stroke. We sought to improve our door to reperfusion times (DTRt) so as to ensure we complied with the Joint Commission CSC measure of 90 minutes. We theorized that by reducing the Door To Puncture time (DTPt), we would promote rapid revascularization and improved clinical outcomes. Our goal was to reduce the DTPt to be consistently less than 75 minutes by ensuring rapid identification, streamlining the activation of the neuroendovascular team and providing education to the providers and ancillary staff. We had two scheduled systems evaluations; Pre-intervention (01/15 to 06/16), and post-intervention (01/17 to 07/17). A total of 82 patients were reviewed, 45 pre-intervention, and 37 post-intervention. During the pre-intervention period, the median DTPt was 98 minutes with an intraquartile range of 75 to 127. In the post-intervention phase the median DTPt was 49 minutes with an intraquartile range of 40 to 82. The p value comparing pre-intervention to post-intervention DTPt was 0.000042. In conclusion, we found that the implementation of rapid identification, streamlined activation and education resulted in a statistically significant decrease in Door To Puncture times from a median of 98 minutes to 49 minutes (p=0.000042). This allowed for a decrease in median Door To Reperfusion time from 130 minutes pre-intervention to 66 minutes post-intervention.

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