You have massively failed at delivering tPA in 3 minutes. What is your followup to still meet the goal of 100% recovery for all? NONE? Then you don't belong in stroke, get the hell out and let better people actually solve stroke!
Electrical 'storms' and 'flash floods' drown the brain after a stroke
In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.
The latest here:
Reducing Door-to-Puncture Times for Mechanical Thrombectomy in a Large Tertiary Hospital
Abstract
Background and Objectives
Endovascular
therapy (EVT) for stroke has emerged as an important therapy for
selected stroke patients, and shorter times to clot removal improve
functional outcomes. EVT requires the close coordination of multiple
departments and poses unique challenges to care coordination in large
hospitals. We present the results of our quality improvement project
that aimed to improve our door-to-groin puncture (DTP) times for
patients who undergo EVT after direct presentation to our emergency
department.
Methods
We
conducted time-motion studies to understand the full process of an EVT
activation and conducted Gemba walks in multiple hospitals. We also
reviewed the literature and interviewed stakeholders to create
interventions that were implemented over 4 Plan-Do-Study-Act (PDSA)
cycles. We retrospectively collected data starting from baseline and
during every PDSA cycle. During each cycle, we studied the impact of the
interventions, adjusted the interventions, and generated further
interventions. A variety of interventions were introduced targeting all
aspects of the EVT process. This included parallel processing to reduce
waiting time, standardization of protocols and training of staff,
behavioral prompts in the form of a stroke clock, and push systems to
empower staff to facilitate the forward movement of the patient. A novel
role-based communication app to facilitate group communications was
also used.
Results
Eighty-eight
patients spanning across 22 months were analyzed. After the final PDSA
cycle, the median DTP time was reduced by 36.5% compared with baseline
(130 minutes (interquartile range [IQR] 111–140) to 82.5 minutes (IQR
74.8–100)). There were improvements in all phases of the EVT process
with the largest time savings occurring in EVT decision to patient
arrival at the angiosuite. Interventions that were most impactful are
described.(So nowhere near fast enough to deliver 100% recovery!)
Discussion
EVT
is a complex process involving multiple processes and local factors.
Analysis of the process from all angles and intervening on multiple
small aspects can add up to significant improvements in DTP times.
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