Process Improvement to Enhance Existing Stroke Team Activity Toward More Timely Thrombolytic Treatment
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Background and Purpose Process improvement (PI) is an approach for enhancing the existingquality improvement process by making changes while keeping the existing process. We haveshown that implementation of a stroke code program using a computerized physician order entrysystem 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 determinedin 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 stepsand treatment before and after implementation of the PI were compared. Results The median time interval from ED arrival to IV thrombolysis in acute stroke patientswas 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 wasachieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from35 to 29 min for complete blood counts (p=0.006)]. Conclusion zPI is effective for continuous improvement of the existing process by reducing thetime delays between ED arrival and IV thrombolysis in acute stroke patients.
Abstract
Background and Purpose Process improvement (PI) is an approach for enhancing the existingquality improvement process by making changes while keeping the existing process. We haveshown that implementation of a stroke code program using a computerized physician order entrysystem 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 determinedin 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 stepsand treatment before and after implementation of the PI were compared. Results The median time interval from ED arrival to IV thrombolysis in acute stroke patientswas 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 wasachieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from35 to 29 min for complete blood counts (p=0.006)]. Conclusion zPI is effective for continuous improvement of the existing process by reducing thetime delays between ED arrival and IV thrombolysis in acute stroke patients.
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