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E-Mail Is an Effective Tool for Rapid Feedback in Acute Stroke.

Sara K Rostanski1,2, Joshua I Stillman3, Lauren R Schaff1,4

  • 1Department of Neurology, Columbia University Medical Center, New York, NY, USA.

The Neurohospitalist
|October 5, 2017
PubMed
Summary

Email feedback significantly improved stroke care metrics, including faster stroke code activation and CT scans. While door-to-needle times did not reach statistical significance, the proportion of patients treated within 45 minutes increased, demonstrating improved acute ischemic stroke management.

Keywords:
educationqualitystroke and cerebrovascular diseasethrombolysis

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Health Informatics

Background:

  • Acute ischemic stroke requires rapid treatment with intravenous tissue plasminogen activator (IV-tPA).
  • Timely administration of IV-tPA is crucial for improving patient outcomes.
  • Effective communication and feedback mechanisms are vital in emergency departments (EDs) for optimizing stroke care.

Purpose of the Study:

  • To evaluate the effectiveness of email-based feedback in improving door-to-needle (DTN) times for acute ischemic stroke patients.
  • To assess the impact of prompt, case-specific data feedback on interdisciplinary communication and stroke care efficiency in the ED.

Main Methods:

  • A quality improvement project was implemented at a high-volume academic stroke center.
  • Clinical details of IV-tPA administrations were shared via email with the treatment team post-case.
  • Door-to-needle and component times were compared between pre-feedback and post-feedback intervention periods.

Main Results:

  • Median door-to-stroke code activation and door-to-CT scan times were significantly reduced in the post-intervention period.
  • While median DTN time decreased, it did not reach statistical significance (54 vs 49 minutes).
  • The proportion of cases achieving the fastest DTN (≤45 minutes) significantly increased from 29.2% to 42.2%.

Conclusions:

  • Email serves as a simple, effective tool for delivering rapid feedback in acute stroke care.
  • This communication strategy enhances interdisciplinary collaboration and promotes improvements in emergency department stroke management.