Improving Quality During Acute Stroke Management Using a Team Approach
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The journey to comprehensive stroke certification identified opportunities for improvement in the treatment of stroke patients in the ED. This allowed the team to examine the process of care delivery. Changing the team dynamics allowed for delivery of quality care with a true team setting.
Relevance/Significance:
This initiative looked at the quality of care provided, established benchmarks and current staffing. Using the team approach to enhance healthcare quality and efficiency is recommended when a complex environment exist. Making changes to all of the listed allowed for better outcomes and future success in the care of stroke patients.
Strategy and Implementation:
Striving for excellence through stroke certification the team embarked on a journey to decrease the door to needle time for TPA and the door to reperfusion time. A thorough assessment of the complex process was completed. A multidisciplinary team was developed and using lean principles the team was able to decrease both door to needle and door to reperfusion times using principles of high performing teams. The multidisciplinary team identified areas of waste or extra work and identified places for these interventions in the future state. The main focus was on defining roles for each of the care providers and creating specific goals and timeframes. Education was provided to all staff and mock drills were used to hardwire the process.
Evaluation:
After the implementation of the process and specific team roles a decrease in door to needle median time from 58 minutes to 43 minutes and door to reperfusion from 189.5 minutes to 121 minutes was achieved. The team communicates better and understands the expectations along with specific time goals for continued real-time evaluation.
Implications for Practice:
An efficient high performing team will result in better quality patient care. This team showed that utilizing team performance principles, success can be achieved. The team is now working on decreasing the door to needle goal even further to 45 minutes 100% of the time.