Optimizing acute stroke treatment process: insights from sub-tasks durations in a prospective observational time and...

Area of Science:

• Neurology
• Healthcare Management
• Medical Process Optimization

Background:

• Rapid treatment is crucial for acute ischemic stroke (AIS) patients.
• Optimizing the Acute Stroke Protocol (ASP) involves minimizing key performance metrics like door-to-needle time (DNT).
• Identifying specific delays within the ASP can reveal opportunities for process improvement.

Purpose of the Study:

• To identify and analyze sub-tasks contributing to delays in AIS treatment within the ASP.
• To compare treatment process durations during routine hours versus after-hours.
• To compare treatment process durations between stroke and non-stroke neurologists.

Main Methods:

• A two-phase prospective observational time and motion study was conducted.
• 34 sub-tasks were identified and categorized.
• Treatment process durations and key performance metrics (DNT, CTNT, CTGP, DGPT) were analyzed for 185 AIS patients.

Main Results:

• Significant delays were observed in triage, registration, history sharing, treatment decisions, and preparation phases.
• Delays were more pronounced when non-stroke neurologists managed cases or during after-hours operations.
• Key performance metrics (DNT, CTNT, CTGP) were significantly prolonged for non-stroke neurologists and after-hours treatment.

Conclusions:

• Specific sub-tasks within the ASP are major sources of delay.
• Targeted interventions focusing on non-stroke neurologists and after-hours care can optimize AIS treatment.
• Improving efficiency in these areas has the potential to significantly enhance patient outcomes.