You know, they say time flies
and boy does it.
We at the Target: Stroke national quality improvement initiative sure think so.
We’ve focused on improving acute ischemic stroke care
and outcomes for eligible stroke patients treated with alteplase.
How are we gonna do it?
Simple: by reducing the door-to-needle time
for every eligible stroke patient.
The goals for Phase II are to reduce those
daunting door-to-needle times to within 60 minutes
and eventually down to within 45 minutes.
But don’t worry, during the video
we’ll review the 12 Key Strategies to help us get there.
Are you ready? Let’s get started!
So you want to know what matters most
when someone suffers a stroke?
The answer is simple: time.
No, seriously.
Every. Second. Matters.
We have a little saying with regard to stroke treatment:
‘Time is Brain.’
Cute, right? But really... it’s no laughing matter.
Every second wasted increases the risk of
irreparable brain damage.
No pressure, right?
Thankfully, we’ve developed 12 Key Strategies
that will help you save time
and drastically affect your patient’s recovery
...and peace of mind.
See what I did there?
Anyway. They say time waits for no one. So, let’s begin.
Key #1: Emergency responders should immediately
pre-notify the hospital when a stroke is recognized.
This early warning means the hospital staff is ready to spring into action,
reducing the time to get the patient to brain-imaging
and ensuring the availability of intravenous alteplase.
Say that three times fast.
Key #2: A stroke toolkit should be used for each patient.
It's like a cheat sheet. The patient gets the proper care
and the attending physician has all the help he or she can get.
Everybody wins.
Key #3: Quick response triage procedures lead to
earlier recognition of strokes and reduce time to treatment.
Remember, we’re counting seconds here, so
mobilize your stroke team as soon as you receive a pre-notification
or a stroke patient is identified. Stat!
Key #4: Implement a system where the entire stroke team
can be activated with a single call.
This Single Call System should include the reservation of a scanner
for brain imaging. Still with me? Good. Just checking.
I know it’s a lot of information, but the clock is ticking. We’d better hustle!
Key #5: Attach a timer or clock to patient's chart,
clipboard or bed. A universal clock allows healthcare providers
to accurately evaluate the patient. Tick, tick, tick, tick.
Key #6: If appropriate, transfer the patient directly from the
triage area to the CT scanner for neuro exam and brain imaging.
The sooner, the better.
Key #7: Perform the CT scan (or MRI) within 25 minutes
of patient’s arrival and complete a full assessment of the scan
within 45 minutes.
Key #8: Lab results should be available no later than
30 minutes after patient’s arrival.
It’s a fast-paced world.
Everyone wants everything right now. And we’re no exception.
So, if standard lab times are too slow,
use alternate Point-of-Care testing for faster results.
We've still got more to learn, but we're running out of time!
We'd better hurry.
Key #9: Mix the alteplase ahead of time.
Prepare the boluse dose and 1-hour infusion pump
as soon as the patient is identified as a candidate.
Just FYI, the drug manufacturer will replace mixed-but-unused medication
in time-critical situations. So,
preparing the drugs ahead of time can only help.
There’s virtually no downside.
Key #10: As soon as the patient is deemed eligible,
administer the alteplase IV.
The initial dosage should be given while the patient is on the CT table.
Keep dosing charts and standardized order sets handy
as they can speed up the process and reduce the risk of errors.
Cheat sheets again. Gotta love ‘em.
Key #11: Put your heads together!
A team based approach to stroke treatment
can increase efficiency and care.
Form a diverse team to review the hospital’s processes and results.
Key #12: Accurately measure and track
performance times in stroke response and treatment.
You won’t be able to improve if you don’t establish a baseline.
Identify areas for improvement and then take action.
Finally, include a process for prompt feedback
to improve common practices.
Tick, tick, tick, tick...
And... done!
Whew! Not bad. Not bad at all.
Now, that was just an overview of the 12 Strategies.
For more detailed information,
reference the full document at the URL below
where you can really 'wrap your head' around the specifics.
Well, it seems we're out of time.
Just remember, preparation is key.
Your patients are depending on you,
but don't worry.
They’re in good hands.