Improving Door to Needle time in Patients for Thrombolysis

Area of Science:

• Neurology
• Emergency Medicine
• Healthcare Quality Improvement

Background:

• Ischemic stroke causes rapid neuronal damage, with millions of brain cells lost per minute without treatment.
• Intravenous tissue plasminogen activator (tPA) is a proven effective treatment for acute ischemic stroke, demonstrated in major trials.
• Minimizing treatment delays, specifically the 'door to needle' (DTN) time, is critical for improving patient outcomes.

Purpose of the Study:

• To measure and evaluate the 'door to needle' (DTN) time for thrombolytic therapy in acute ischemic stroke patients.
• To identify factors contributing to delays in administering thrombolysis.
• To implement and assess changes aimed at reducing DTN time and improving patient care.

Main Methods:

• Data collection on DTN times during November 2015, December 2015, and January 2016.
• Analysis of identified delays within the stroke treatment pathway.
• Implementation of a change: prioritizing core medical trainees to respond to thrombolysis calls.

Main Results:

• The mean DTN time was reduced significantly over the study period.
• Mean DTN time decreased from 74 minutes in November to 43 minutes in January.
• The implemented change successfully shortened the time for physician assessment and thrombolytic agent administration.

Conclusions:

• Assigning on-call core medical trainees as a priority for thrombolysis calls effectively reduces DTN times in acute ischemic stroke.
• The quality improvement project successfully decreased treatment delays, leading to better patient outcomes.
• The initiative also provided valuable training and skill development for medical trainees.