J Clin Neurol.  2014 Oct;10(4):328-333. 10.3988/jcn.2014.10.4.328.

Process Improvement to Enhance Existing Stroke Team Activity Toward More Timely Thrombolytic Treatment

• Cho HJ
• Lee KY
• Nam HS
• Kim YD
• Song TJ
• Jung YH
• Choi HY
• Heo JH

• KMID: 2287512
• DOI: http://doi.org/10.3988/jcn.2014.10.4.328

Abstract

BACKGROUND AND PURPOSE
Process improvement (PI) is an approach for enhancing the existing quality improvement process by making changes while keeping the existing process. We have shown that implementation of a stroke code program using a computerized physician order entry system is effective in reducing the in-hospital time delay to thrombolysis in acute stroke patients. We investigated whether implementation of this PI could further reduce the time delays by continuous improvement of the existing process.
METHODS
After determining a key indicator [time interval from emergency department (ED) arrival to intravenous (IV) thrombolysis] and conducting data analysis, the target time from ED arrival to IV thrombolysis in acute stroke patients was set at 40 min. The key indicator was monitored continuously at a weekly stroke conference. The possible reasons for the delay were determined in cases for which IV thrombolysis was not administered within the target time and, where possible, the problems were corrected. The time intervals from ED arrival to the various evaluation steps and treatment before and after implementation of the PI were compared.
RESULTS
The median time interval from ED arrival to IV thrombolysis in acute stroke patients was significantly reduced after implementation of the PI (from 63.5 to 45 min, p=0.001). The variation in the time interval was also reduced. A reduction in the evaluation time intervals was achieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from 35 to 29 min for complete blood counts (p=0.006)].
CONCLUSIONS
PI is effective for continuous improvement of the existing process by reducing the time delays between ED arrival and IV thrombolysis in acute stroke patients.

Keyword

stroke; thrombolysis; quality improvement; emergency medical services; stroke teams; code stroke

MeSH Terms

Blood Cell Count
Emergency Medical Services
Emergency Service, Hospital
Humans
Medical Order Entry Systems
Quality Improvement
Statistics as Topic
Stroke*

Figure

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  Fig. 1 The process improvement step designed to reduce the time delay from arrival at the emergency department (ED) to intravenous (IV) thrombolysis. BEST: Brain salvage through Emergent Stroke Therapy, CPOE: computerized physician order entry.

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  Fig. 2 A run chart showing time interval from arrival at the emergency department to intravenous thrombolysis in each acute stroke patient over time. rt-PA: recombinant tissue plasminogen activator.

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