E-Mail Is an Effective Tool for Rapid Feedback in Acute Stroke. (October 2017)

• Record Type: Journal Article
• Authors: Rostanski, Sara K.; Stillman, Joshua I.; Schaff, Lauren R.; Perdomo, Crismely A.; Liberman, Ava L.; Miller, Eliza C.; Marshall, Randolph S.; Willey, Joshua Z.; Williams, Olajide
• Is Part Of: Neurohospitalist. Volume 7:Number 4(2017:Oct.)
• Page Start: 159
• Page End: 163
• Publication Date: 2017-10
• Subjects: stroke and cerebrovascular disease -- quality -- education -- thrombolysis; Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; 616.8
• DOI: 10.1177/1941874416689358
• Languages: English
• ISSNs: 1941-8744

Abstract

Objective: To determine whether e-mail is a useful mechanism to provide prompt, case-specific data feedback and improve door-to-needle (DTN) time for acute ischemic stroke treated with intravenous tissue plasminogen activator (IV-tPA) in the emergency department (ED) at a high-volume academic stroke center. Methods: We instituted a quality improvement project at Columbia University Medical Center where clinical details are shared via e-mail with the entire treatment team after every case of IV-tPA administration in the ED. Door-to-needle and component times were compared between the prefeedback (January 2013 to March 2015) and postfeedback intervention (April 2015 to June 2016) periods. Results: A total of 273 cases were included in this analysis, 102 (37%) in the postintervention period. Median door-to-stroke code activation (2 vs 0 minutes, P < .01), door-to-CT Scan (21 vs 18 minutes, P < .01), and DTN (54 vs 49 minutes, P = .17) times were shorter in the postintervention period, although the latter did not reach statistical significance. The proportion of cases with the fastest DTN (≤45 minutes) was higher in the postintervention period (29.2% vs 42.2%, P = .03). Conclusion: E-mail is a simple and effective tool to provide rapid feedback and promote interdisciplinary communication to improve acute stroke care in the ED.