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Implementation of an institution-wide acute stroke algorithm: Improving stroke quality metrics.
Scott L Zuckerman1, Jordan A Magarik1, Kiersten B Espaillat2
1Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Surgical Neurology International
|February 2, 2017
Summary
Implementing a revised stroke algorithm significantly reduced door to computed tomography (CT) and door to neurology times. This quality improvement initiative streamlined stroke care, though door to tPA administration time showed nonsignificant improvement.
Area of Science:
- Neurology
- Healthcare Quality Improvement
- Medical Informatics
Background:
- Vanderbilt University Medical Center implemented an updated stroke algorithm in May 2012.
- The revision aimed to reduce variability and streamline stroke patient care.
Purpose of the Study:
- To describe the implementation process of a new stroke algorithm.
- To compare pre- and post-implementation quality improvement metrics, including door to computed tomography (DTCT), door to neurology (DTN), and door to tPA administration (DTT) times.
Main Methods:
- An updated institutional stroke algorithm was implemented in May 2012.
- Three primary stroke quality improvement metrics (DTCT, DTN, DTT) were evaluated across four 3-month periods (one pre-implementation, three post-implementation).
Main Results:
- Average DTCT decreased from 39.9 to 12.8 minutes (P < 0.001).
- Average DTN decreased from 34.1 to 8.2 minutes (P ≤ 0.001).
- Average DTT decreased from 62.5 to 43.5 minutes (P = 0.17).
Conclusions:
- The revised stroke protocol significantly reduced DTCT and DTN.
- The protocol led to a nonsignificant improvement in DTT.
- Prioritizing neurointervention streamlined stroke care and improved key time metrics.
