Implementation of an institution-wide acute stroke algorithm: Improving stroke quality metrics

Abstract

Background:In May 2012, an updated stroke algorithm was implemented at Vanderbilt University Medical Center. The current study objectives were to: (1) describe the process of implementing a new stroke algorithm and (2) compare pre- and post-algorithm quality improvement (QI) metrics, specificaly door to computed tomography time (DTCT), door to neurology time (DTN), and door to tPA administration time (DTT).Methods:Our institutional stroke algorithm underwent extensive revision, with a focus on removing variability, streamlining care, and improving time delays. The updated stroke algorithm was implemented in May 2012. Three primary stroke QI metrics were evaluated over four separate 3-month time points, one pre- and three post-algorithm periods.Results:The following data points improved after algorithm implementation: average DTCT decreased from 39.9 to 12.8 min (P < 0.001); average DTN decreased from 34.1 to 8.2 min (P ≤ 0.001), and average DTT decreased from 62.5 to 43.5 min (P = 0.17).Conclusion:A new stroke protocol that prioritized neurointervention at our institution resulted in significant lowering in the DTCT and DTN, with a nonsignificant improvement in DTT.

Ventriculostomy supply cart decreases time-to-external ventricular drain placement in the emergency department

“…Surveying all the departments involved in the decision-making and placement of EVDs enabled us to identify potential time delays. [ 24 ] Process mapping and root cause analysis revealed decentralized supply storage as a significant contributor to delayed EVD placement[ 4 , 17 , 24 ] [ Figures 1 and 2 ]. We developed and implemented an EVD supply cart for the ED and prospectively assessed the impact on time-to-EVD placement.…”

Erratum: Implementation of an institution wide acute stroke algorithm: Improving stroke quality metrics

“…7 of Surgical Neurology International[1], the name of the author in the “How to cite this article” section is written incorrectly as “Kumar NG” instead of “Ganesh Kumar N”. The section should read correctly as “Zuckerman SL, Magarik JA, Espaillat KB, Ganesh Kumar N, Bhatia R, Dewan MC, et al .…”

“…In the article titled “Implementation of an institution wide acute stroke algorithm: Improving stroke quality metrics”, published in pages S1041-S1048, supplementary issue 41, vol. 7 of Surgical Neurology International[ 1 ], the name of the author in the “How to cite this article” section is written incorrectly as “Kumar NG” instead of “Ganesh Kumar N”. The section should read correctly as “Zuckerman SL, Magarik JA, Espaillat KB, Ganesh Kumar N, Bhatia R, Dewan MC, et al .…”