Improving stroke alert response time: Applying quality improvement methodology to the inpatient neurologic emergency

Authors

  • Ethan Cumbler MD,

    Corresponding author
    1. Departments of Medicine, Neurosurgery, and Neurology, University of Colorado, University of Colorado School of Medicine, Denver Colorado
    • Department of Medicine, University of Colorado Hospital, PO Box 6510 F782, 12605 E 16th Ave, Aurora, CO 80045
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    • Tel. 720-848-4289

  • Rebekah Zaemisch MD,

    1. Departments of Medicine, Neurosurgery, and Neurology, University of Colorado, University of Colorado School of Medicine, Denver Colorado
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  • Alexandra Graves NP,

    1. Departments of Medicine, Neurosurgery, and Neurology, University of Colorado, University of Colorado School of Medicine, Denver Colorado
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  • Kerry Brega MD,

    1. Departments of Medicine, Neurosurgery, and Neurology, University of Colorado, University of Colorado School of Medicine, Denver Colorado
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  • William Jones MD

    1. Departments of Medicine, Neurosurgery, and Neurology, University of Colorado, University of Colorado School of Medicine, Denver Colorado
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  • Disclosure: None of the authors have conflicts of interest with for-profit organizations relevant to this publication. Dr Cumbler serves as the Course Director for the National Stroke Association's In-Hospital Stroke Quality Improvement Initiative and has spoken on quality of stoke care for the American Heart Association/American Stroke Association. Dr Jones has done expert testimony for cerebrovascular disease litigation.

Abstract

BACKGROUND:

Stroke often leaves its victims with devastating disabilities if not treated promptly. Guidelines recommend that brain imaging be obtained within 25 minutes, yet this benchmark is rarely achieved for the in-hospital stroke.

PURPOSE:

To reduce time to evaluation for strokes occurring in patients already hospitalized, through systematic analysis of current processes and application of standardized quality improvement methodology.

METHODS:

Improving the quality of care for in-hospital stroke patients involved 4 key steps: (1) creation of a detailed process map to identify inefficiencies in the current process for identifying and treating hospitalized stroke patients, (2) development of an optimized care pathway, (3) implementation of a checklist of optimal practices for the acute stroke response team and nursing staff, and (4) real-time feedback. Time from stroke alert to initiation of computed tomography (CT) scan was prospectively tracked for the 6-month period prior to intervention. After a 3-month interval for intervention roll-out, the response times for the pre-intervention period were compared to a 6-month post-intervention evaluation period.

RESULTS:

Pre-intervention median inpatient stroke alert-to-CT time was 69.0 minutes, with 19% meeting the goal of 25 minutes from alert to CT time. Post-intervention median inpatient stroke alert-to-CT time was reduced to 29.5 minutes, with 32% at goal (P < 0.0001).

CONCLUSIONS:

This inpatient stroke alert quality improvement initiative decreased median inpatient alert-to-CT time by 57%, and demonstrated that speed of in-hospital stroke evaluation can be improved through systematic application of quality improvement principles. Journal of Hospital Medicine 2012; © 2011 Society of Hospital Medicine

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