Process Improvement to Enhance Existing Stroke Team Activity Toward More Timely Thrombolytic Treatment
Journal of Clinical Neurology 2014³â 10±Ç 4È£ p.328 ~ p.333
Á¶ÇÑÁø(Cho Han-Jin) - Yonsei University College of Medicine Department of Neurology
ÀÌ°æ¿(Lee Kyung-Yul) - Yonsei University College of Medicine Department of Neurology
³²È¿¼®(Nam Hyo-Suk) - Yonsei University College of Medicine Department of Neurology
±è¿µ´ë(Kim Young-Dae) - Yonsei University College of Medicine Department of Neurology
¼ÛÅÂÁø(Song Tae-Jin) - Yonsei University College of Medicine Department of Neurology
Á¤¿äÇÑ(Jung Yo-Han) - Yonsei University College of Medicine Department of Neurology
ÃÖÇØ¿¬(Choi Hye-Yeon) - Yonsei University College of Medicine Department of Neurology
ÇãÁöȸ(Heo Ji-Hoe) - Yonsei University College of Medicine Department of Neurology
Abstract
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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stroke, thrombolysis, quality improvement, emergency medical services, stroke teams, code stroke
KMID :
1130620140100040328
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