Enhancing acute stroke services: a quality improvement project

BMJ Open Quality
Keith McGrathDeclan Lyons

Abstract

In a busy stroke centre in Ireland, care for acute stroke was provided by a mixture of general physicians. In acute ischaemic stroke, speed is essential for good outcomes. To improve acute stroke services and decrease door-to-needle (DTN) time to less than 60 min by December 2016 in patients with acute ischaemic stroke who are eligible for intravenous thrombolysis.Design: A quality improvement (QI) project was undertaken in a 438 bed, acute, university hospital. Mixture of qualitative and quantitative data collected. A process map and driver diagram were created. Interventions tested with Plan-Do-Study-Act cycles. Times compared between July and December 2015, January and July 2016, July and December 2016, when a new stroke team and pathway were introduced. Between July and December 2015, the total number of ischaemic strokes was 216. 17 were thrombolysed (7.8%). Median door-to-CT (DTCT) time was 36 min (range 21-88). Median DTN time was 99 min (range 52-239). Between July and December 2016, there were 214 ischaemic strokes. 29 were thrombolysed (13.5%). 9 were seen directly by the stroke team during normal hours. With stroke team involvement, median DTCT time was 34 min (range 14-60) and DTN time was 43.5 min (range 24-65). Th...Continue Reading

References

Dec 13, 2005·Stroke; a Journal of Cerebral Circulation·Jeffrey L Saver
May 22, 2016·Clinical Radiology·UNKNOWN The Royal College Of RadiologistsUNKNOWN Administration Of Radioactive Substances Advisory Committee

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