Background: The American Stroke association has set targets for certified stroke centers achieving door to needle times within 60 minutes for 75% of cases, and less than 45 minutes for half of the cases. For each 15 minute reduction in delay, an estimated 4% improvement is realized in clinical outcomes. However, many barriers interfere with the hospital’s ability to attain a reduction both in clinical decision making and treatment times.
Purpose: This quality improvement project examined the impact of a work flow re-design using a Stroke "Pit Stop" protocol. The project was designed to improve patient care and determine appropriate institutional practices at our hospital by evaluating patient outcomes.
Methods: A protocol was developed where stroke code patients was rapidly evaluated for tPA candidacy and tasks were simultaneously completed by physicians, nurses, and ancillary staff prior to CT imaging. All code stroke cases from a single hospital were evaluated 6 month pre (2016 July-December), and 6 months post (2017 January - June) intervention. Average door to needle, proportion of cases below 60 minutes and 45 minutes were compared between the two time periods.
Results: Mean door to needle time statistically significantly decreased from 63 ± 33 minutes to 46 ± 13 minutes (p= 0.044). Furthermore, the percentage of patients receiving tPA under 60 minutes and under 45 minutes increased from 63% to 79% and from 29% to 47% respectively.
Conclusion: Instituting the Stroke "Pit Stop" statistically significant decreased door to needle times helping the hospital meet national guidelines.