LAUSR

Background: Up to July 2016, in one of the busiest stroke centres in Ireland, care for acute stroke was provided by a mixture of general physicians. Our primary aim was to improve the acute stroke service and used the key performance indicator of decreasing the door-to-needle (DTN) time to less than 60 minutes by December 2016 in patients with acute ischaemic stroke who are eligible for intravenous thrombolysis. Methods: A Quality Improvement Project was undertaken. A stroke registrar joined the Stroke CNS, and a new on-call rota for stroke consultants was implemented. A Driver Diagram was produced and 7 primary drivers were identified: early identification & prioritisation of patients, new integrated pathway, early clinical assessment, early bloods, early CT imaging, early administration, and admission to stroke unit. Time from Doorto-CT (DTCT) and Door-to-Needle were recorded for all patients who presented with symptoms of acute stroke. Times were compared between January–July 2016, and July– December 2016, when a new stroke team and pathway were introduced. Results: Between January and July 2016, 15 patients were thrombolysed. Between July and December 2016, 29 patients were thrombolysed, of whom 9 were seen directly by the stroke team during normal hours, Monday-Friday. With stroke team involvement, comparing January to July 2016 and July to December 2016, average DTCT time fell from 42.5 to 34.6 minutes (18.5% decrease), average DTN time fell from 96.3 to 42.8 minutes (55.56% decrease). However, out of hours, between July and December 2016, average DTCT time was 62.35 minutes and DTN time was 115.4 minutes. These were 44.5% and 62.9% higher, respectively, than the dedicated stroke team. Conclusions: Often, much emphasis is placed specifically on IV thrombolysis administration. As important, however, if not more so, for overall success is the pathway the patient takes and the team that guides them through it.