The 'pit-crew' model for improving door-to-needle times in endovascular stroke therapy: a Six-Sigma project. (11th January 2016)

• Record Type: Journal Article
• Authors: Rai, Ansaar T; Smith, Matthew S; Boo, SoHyun; Tarabishy, Abdul R; Hobbs, Gerald R; Carpenter, Jeffrey S
• Is Part Of: Journal of neurointerventional surgery. Volume 8:Number 5(2016)
• Page Start: 447
• Page End: 452
• Publication Date: 2016-01-11
• Subjects: Stroke -- Standards; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2015-012219
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Delays in delivering endovascular stroke therapy adversely affect outcomes. Time-sensitive treatments such as stroke interventions benefit from methodically developed protocols. Clearly defined roles in these protocols allow for parallel processing of tasks, resulting in consistent delivery of care. Objective: To present the outcomes of a quality-improvement (QI) process directed at reducing stroke treatment times in a tertiary level academic medical center. Methods: A Six-Sigma-based QI process was developed over a 3-month period. After an initial analysis, procedures were implemented and fine-tuned to identify and address rate-limiting steps in the endovascular care pathway. Prospectively recorded treatment times were then compared in two groups of patients who were treated 'before' (n=64) or 'after' (n=30) the QI process. Three time intervals were measured: emergency room (ER) to arrival for CT scan (ER–CT), CT scan to interventional laboratory arrival (CT–Lab), and interventional laboratory arrival to groin puncture (Lab–puncture). Results: The ER–CT time was 40 (±29) min in the 'before' and 26 (±15) min in the 'after' group (p=0.008). The CT–Lab time was 87 (±47) min in the 'before' and 51 (±33) min in the 'after' group (p=0.0002). The Lab–puncture time was 24 (±11) min in the 'before' and 15 (±4) min in the 'after' group (p<0.0001). The overall ER–arrival to groin-puncture time was reduced from 2 h, 31 min (±51) min in the 'before' to 1 h, 33 min (±37) min in the 'after' group, (p<0.0001). The improved times were seen for both working hours and off-hours interventions. Conclusions: A protocol-driven process can significantly improve efficiency of care in time-sensitive stroke interventions.