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Process improvement to enhance existing stroke team activity toward more timely thrombolytic treatment

 Han Jin Cho  ;  Kyung Yul Lee  ;  Hyo Suk Nam  ;  Young Dae Kim  ;  Tae Jin Song  ;  Yo Han Jung  ;  Hye Yeon Choi  ;  Ji Hoe Heo 
 JOURNAL OF CLINICAL NEUROLOGY, Vol.10(4) : 328-333, 2014 
Journal Title
Issue Date
code stroke ; emergency medical services ; quality improvement ; stroke ; stroke teams ; thrombolysis
BACKGROUND AND PURPOSE: Process improvement (PI) is an approach for enhancing the existing quality improvement process by making changes while keeping the existing process. We have shown that implementation of a stroke code program using a computerized physician order entry system is effective in reducing the in-hospital time delay to thrombolysis in acute stroke patients. We investigated whether implementation of this PI could further reduce the time delays by continuous improvement of the existing process. METHODS: After determining a key indicator [time interval from emergency department (ED) arrival to intravenous (IV) thrombolysis] and conducting data analysis, the target time from ED arrival to IV thrombolysis in acute stroke patients was set at 40 min. The key indicator was monitored continuously at a weekly stroke conference. The possible reasons for the delay were determined in cases for which IV thrombolysis was not administered within the target time and, where possible, the problems were corrected. The time intervals from ED arrival to the various evaluation steps and treatment before and after implementation of the PI were compared. RESULTS: The median time interval from ED arrival to IV thrombolysis in acute stroke patients was significantly reduced after implementation of the PI (from 63.5 to 45 min, p=0.001). The variation in the time interval was also reduced. A reduction in the evaluation time intervals was achieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from 35 to 29 min for complete blood counts (p=0.006)]. CONCLUSIONS: PI is effective for continuous improvement of the existing process by reducing the time delays between ED arrival and IV thrombolysis in acute stroke patients.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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