Using LEAN methodology to expedite the treatment of acute ischemic stroke in the emergency room

Stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States, and timely administration of tissue plasminogen activator (alteplase) is a key predictor of post-stroke survival and disability. The authors explain how a process improvement team utilized LEAN methodology to decrease alteplase administration ("door to needle") time by almost 50% at a busy, high-acuity hospital emergency room in Houston, Texas. The authors will explain the process that was followed, the post-implementation results, and lessons learned.