Background: For acute ischemic stroke patients, reduced door-to-needle (DTN) times are associated with better clinical outcomes. Our Stroke Center evaluated DTN time for thrombolysis cases since 2004 to identify opportunities to reduce time to treatment. In October 2014, the American Heart Association/American Stroke Association introduced Target: Stroke Phase II to challenge Get With the Guidelines-Stroke participating hospitals to reduce time to tPA. In January 2015 our center adopted the goal DTN time of 45 minutes. Many best practice strategies outlined in Target: Stroke Phase II were previously implemented, including: EMS pre-notification, single call activation, rapid evaluation by the Stroke Team, and rapid completion and interpretation of brain imaging. In 2015, our stroke center was able to administer tPA within 45 minutes of Emergency Department (ED) arrival in 29% of cases (n=35).
Purpose: The purpose of this project is reduce DTN times by recognizing the efforts of the interdisciplinary team in cases of timely thrombolysis.
Methods: A team-based approach is used for all ED Stroke Alerts. Starting January 2016, for each case of tPA administration within 45 minutes of arrival, every team member was recognized for their contribution in providing “Lightning Fast Stroke Care.” A flyer was developed highlighting details of the case, clinical outcome, and recognizing every team member who participated in the care of the patient. Persons recognized include: EMS, ED nurses, techs and physicians, registration, radiology techs, laboratory staff, pharmacists, Stroke Team physicians and trainees. Flyers were distributed and displayed publically. Each team member recognized received a lightning bolt pin, in addition to a copy of the flyer.
Results: In 2016, over 500 pins were awarded for Lightning Fast Stroke Treatment, and the lightning bolt pin became a badge of honor recognized throughout the medical center. Our Stroke Center was able to administer tPA within 45 minutes of ED arrival in 58% of cases (n=40). Without making other changes to the process our percent of cases achieving DTN within 45 minutes doubled.
Conclusion: Recognition and feedback are important to providing team-based care and have made a significant sustainable impact on DTN times.