Radiographics 2017 Sep-Oct;37(5):1559-1568. Epub 2017 Aug 18.
From the Departments of Radiology (A.K., L.J.M., D.M., C.Z., M.W., D.B.L.), Neurology and Neurological Sciences (S.C., N.V.), and Emergency Medicine (G.O.), Stanford University School of Medicine, Stanford Hospital and Clinics, Stanford, Calif; and Neuroscience Service Line, Department of Medicine, Christiana Care Health System, Newark, Del (W.A.T.).
Guided quality improvement (QI) programs present an effective means to streamline stroke code to computed tomography (CT) times in a comprehensive stroke center. Applying QI methods and a multidisciplinary team approach may decrease the stroke code to CT time in non-prenotified emergency department (ED) patients presenting with symptoms of stroke. The aim of this project was to decrease this time for non-prenotified stroke code patients from a baseline mean of 20 minutes to one less than 15 minutes during an 18-week period by applying QI methods in the context of a structured QI program. By reducing this time, it was expected that the door-to-CT time guideline of 25 minutes could be met more consistently. Through the structured QI program, we gained an understanding of the process that enabled us to effectively identify key drivers of performance to guide project interventions. As a result of these interventions, the stroke code to CT time for non-prenotified stroke code patients decreased to a mean of less than 14 minutes. This article reports these methods and results so that others can similarly improve the time it takes to perform nonenhanced CT studies in non-prenotified stroke code patients in the ED. RSNA, 2017.