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Straight-To-CT Plan Helps Stroke Patients

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Doctors and other staff in the emergency department at Barnes-Jewish Hospital in St. Louis borrowed a technique from Toyota to greatly reduce the average time from patient arrival to the beginning of treatment—from 58 to 37 minutes.

The shorter that time, known as door-to-needle time, the better the chance of reducing or avoiding brain damage associated with a stroke.

Toyota’s lean manufacturing process involves, among other things, getting input from all members of the team to identify and eliminate inefficiencies. So, said Jin-Moo Lee, MD, PhD, senior author of a study about the hospital’s initiative:

We sought suggestions from everyone involved, from the paramedics who bring in patients to admitting clerks, radiology technologists, nurses, and physicians.

Dr. Lee is associate professor of neurology at Washington University School of Medicine in St. Louis and an attending physician for stroke service at Barnes-Jewish. He was quoted in a Washington University news release. The study was presented at the International Stroke Conference earlier this year and, according to the news release, is to be published in Stroke.

“Once the inefficient steps were identified, we developed a completely new protocol that eliminated them,” Dr. Lee said. “This new treatment protocol helped us achieve one of the fastest door-to-needle times in the country.”

For example, the team noted that stroke patients usually got moved several times before treatment. So instead of starting patients in an examination room, paramedics now bring them directly to the CT scanner for evaluation.

The hospital initiated the new procedures in March 2011. They increased the percentage of patients treated within an hour of the onset of symptoms—the “golden hour”—from 52 percent to 78 percent.

After the new procedures were put in place, the researchers monitored patients to see if the new protocol resulted in side effects, such as hemorrhages, or an increased number of patients unnecessarily getting the clot-busting drug tPA. It didn’t.

“National guidelines suggest that door-to-needle times should be under 60 minutes, yet these guidelines do not state how this can be achieved,” said Dr. Lee, as quoted in an American Heart Association news release. “Lean process improvements methodology can be effectively applied towards achieving this and other process improvement goals.”

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