Citrus Memorial is a 204-bed hospital located in Inverness, Florida. They are a certified Primary Stroke Center by The Joint Commission.
An inconsistent approach to the stroke treatment process led to alteplase administration delays and Door-to-Needle (DTN) times greater than the 45-minute American Stroke Association goal.
In December 2018, Citrus Memorial implemented the American Stroke Association’s pit stop concept for stroke treatment. This process requires a team approach to “swarm” the patient, initiate a quick registration, assess, and obtain vital signs. A telehealth cart was placed in the pit stop area to allow for a TeleSpecialists’ physician to observe and obtain pertinent patient information necessary to determine whether the patient has met criteria for pre-mixing alteplase. Simultaneously, the ED provider enters stroke alert orders to initiate imaging to rule out hemorrhage or other prohibiting factors for alteplase. Within three minutes, the patient is escorted to Radiology to continue with treatment.
Further education was provided to ED staff on TeleSpecialists’ SAVES tool to assist in identifying stroke symptoms on every patient.
Collectively, these process changes decreased DTN times by 15%, with cases as low as 19 minutes from patient arrival to treatment with alteplase, helping Citrus Memorial meet the national guidelines.