Time is brain. The speed in which a stroke patient receives clot-busting tPA (aka the door-to-needle time) undoubtedly impacts their future quality of life. Upon ambulance arrival to hospital, the goal is to get the patient assessed by the physician and down for a CT scan as quickly as possible to determine whether they are a candidate for tPA (only 1 in 5 patients qualify, as it depends on the type of stroke).
At QHC, we do this well, but there’s room for improvement. During a two-day Kaizen event in July, a large group of highly-engaged QHC staff, physicians and community partners explored how we can make small changes to improve door-to-needle times.
“Belleville General Hospital is a Telestroke site, meaning we don’t have a neurologist on site so we connect to one via video conference,” explained Derk Damron, District Stroke Coordinator. “Since we already have a good process for this, we just need a few tweaks to shave 12-15 minutes off to reach our goal of a 30-minute median door-to-needle time.”
One simple but impactful change is being implemented by Paramedics. After their initial call to the hospital to inform that a stroke patient is on the way, they will call back again when they are 10 minutes away from the hospital so an overhead page can go out, letting the stroke team know to take their places. The paramedic will give the patient’s health card number during the call so patient registration can begin and the physician can review the patient’s medical history in advance.
New, dedicated phone lines in the rooms where stroke patients are assessed will expedite discussions with Telestroke, leading to speedier decisions on tPA. Once the decision has been made, the nurse can start mixing tPA even while the physician is still in discussion with Telestroke.
“The team learned that a lot of processes can be done in parallel,” said James Russell, Director of Process Improvement. “The more time we can save upfront, the more time we have for the tPA decision.”
Role clarity was also established for physicians and nurses, helping to ease frustration that can occur between Emergency and ICU.
“We had amazing representation from every group,” said Derk. “Everyone was really positive and had the clear focus of improving to be able to meet our door-to-needle goal. Even a small improvement can mean so much to our patients’ lives.”