Lima Memorial is a 329-bed health system providing care to a 10 county region with a total population of 376,797. Their annual ED volume of emergency visits is 32,023. As of August 2021, stroke alert volume increased 25% over 2020.
The Door-to-Needle (DTN) average for alteplase administration was greater than 60 minutes between August and November in 2020.
Lima Memorial developed a process improvement plan by collaborating with their TeleSpecialists Quality Specialist to conduct an intense data review of the current state of the stroke program and a root cause analysis.
First, a significant change in the workflow process was launched by implementing a priority button in the ED. The triage nurse is empowered to activate the stroke alert by pressing the priority button for any patient that presents with a BEFAST screening.
Second, a robust stroke education plan was rolled out to include weekly education with the ED staff to include program updates, stroke alert process and new implementations. Four mock stroke alerts were conducted over a year with their TeleSpecialists Regional Medical Director, and post mock alert reviews were performed to provide valuable feedback.
Lastly, an education program was presented to EMS personnel on stroke identification and pre-notification based on Cincinnati stroke scale findings. An amazing 35% reduction in the DTN average was achieved between Q4 2020 and Q2 2021!