194Save The Brain Campaign: Reducing Door to CT Times for Acute Stroke

Abstract

Background: In acute ischaemic stroke rapid access to computed tomography (CT) imaging is essential to facilitate early thrombolysis or thrombectomy. International guidelines recommend door to CT in less than 25 minutes, however, door to CT times in this large teaching hospital exceeded this. The aim of this quality improvement project was to reduce the median door (registration time) to CT time to less than 25 minutes for possible strokes presenting within 12 hours of symptom onset or unknown onset 8am to 5 pm Monday to Friday. Methods: The Institute for Healthcare Improvement quality improvement (QI) methodology was used. Baseline door to CT time data were collected. A comprehensive process analysis and benchmarking exercise was carried out. Successive PDSA (Plan, Do, Study, Act) cycles were used to test and implement change ideas. Outcome and process measures were collected and displayed on run charts. Change ideas included early stroke team involvement through ambulance pre-alert, introduction of a single stroke alert number, streamlining CT request process, removal of unnecessary or duplicate process steps, improvement of team work and staff education. The primary outcome measure was door to first CT slice time. Results: Baseline median door to CT time in October 2016 was 120 minutes. With implementation of the quality improvement initiative door to CT times improved over the following 4 month period with a median registration to CT of 11 minutes in February 2017, 17 minutes in March 2017 and a record door to CT time of 6 minutes. Conclusions: This project has resulted in significant improvements in door to CT times for people presenting with possible stroke. This was achieved through QI methodologies without allocation of any additional resources or funding.