Improving Door to Groin Puncture Time for Mechanical Thrombectomy via Iterative Quality Protocol Interventions

Area of Science:

• Neurology
• Interventional Cardiology
• Healthcare Quality Improvement

Background:

• Delays in door to groin puncture time (DGPT) for acute ischemic stroke with large vessel occlusions (LVO) correlate with poorer clinical outcomes.
• Minimizing DGPT is crucial for effective endovascular stroke treatment.

Purpose of the Study:

• To implement and evaluate a quality improvement (QI) protocol aimed at reducing DGPT for LVO stroke patients.
• To assess the impact of QI measures on achieving a target DGPT of 90 minutes or less.

Main Methods:

• A retrospective analysis of 63 patients undergoing endovascular stroke treatment was conducted.
• Patients were grouped based on intervention dates, serving as a proxy for QI protocol implementation.
• Multivariate regression analyses identified predictors of prolonged DGPT and target compliance.

Main Results:

• The implementation of QI protocols significantly improved DGPT compliance.
• Patients treated after full QI implementation were 3.2 times more likely to meet the DGPT target.
• Multivariate analysis confirmed shorter DGPT and higher likelihood of achieving the goal in the final cohort.

Conclusions:

• Iterative quality improvement processes are effective in significantly reducing DGPT.
• A formal QI system is valuable for academic comprehensive stroke centers to enhance treatment efficiency.