Abstract:
BACKGROUND AND PURPOSE:Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol. METHODS:In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the tPA-treated patients in the "pre-VSA" epoch with the "post-VSA" epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. RESULTS:The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 minutes versus 39 minutes (P<0.0001) and 52% versus 78% (P<0.0001), respectively, with no change in symptomatic hemorrhage rate. CONCLUSIONS:Lean process improvement methodology can expedite time-dependent stroke care without compromising safety.
journal_name
Strokejournal_title
Strokeauthors
Ford AL,Williams JA,Spencer M,McCammon C,Khoury N,Sampson TR,Panagos P,Lee JMdoi
10.1161/STROKEAHA.112.670687subject
Has Abstractpub_date
2012-12-01 00:00:00pages
3395-8issue
12eissn
0039-2499issn
1524-4628pii
STROKEAHA.112.670687journal_volume
43pub_type
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