Decreasing “door to admission” times for intravenous tPA treated patients: A single comprehensive stroke center experience
Girotra T, Raper LA, Schultz L, Alsrouji O, Katramados A, Cohen L, Brady M, and Miller DJ. Decreasing “door to admission” times for intravenous tPA treated patients: A single comprehensive stroke center experience. Stroke 2018; 49(Suppl 1):WP353.
Introduction: AHA's Get with The Guidelines (GTWG) initiative has recommended “door to admission” time for patients receiving IV tPA to beours, complicated administrative steps and coordination required to admit patients often leads to delays. There has been a paucity of studies aiming to streamline this process for patients treated with IV tPA. Aim: To assess whether having a dedicated rapid response team (RRT) RN within the ED to coordinate care of patients receiving IV tPA reduces “door to admission” times. Methods: A policy of notifying RRT of all patients eligible for IV tPA was implemented in the ED. The responsibility of RRT was to coordinate care between neurology resident, ED nurse, acute stroke unit (ASU) charge nurse and admissions office to ensure timely completion of steps required for admission. “Door to admission” times were collected prospectively for 3 months before and after intervention. The compliance of recording neuro checks and vital signs per AHA guidelines for post tPA care were also measured. Wilcoxon two sample test was used to analyze time variables and compliance rates. Results: The post intervention group had significantly decreased “door to admission” and “bolus to admission” times (see table). Also, significantly fewer patients had >1 vital signs checks miss in post-intervention group (6% vs 38%; p=0.033). There was no significant increase in the compliance rate of neuro checks. Discussion: By adding RRT in coordination of care for IV tPA patients in the ED, we were able to drastically reduce our door to admission times. The improvement was because of faster placement and prioritized processing of the admission orders. RRT acted as a “control center” relaying vital information to admission office and ASU charge nurse. This also freed ED RN to improve compliance rate of recording vital signs in IV tPA patients. Similar interventions can be used by other centers to decrease their “door to admission” times. (Table Presented).