Sara K Rostanski1,2, Joshua I Stillman3, Lauren R Schaff1,4, Crismely A Perdomo1,5, Ava L Liberman6, Eliza C Miller1, Randolph S Marshall1, Joshua Z Willey1, Olajide Williams1. 1. Department of Neurology, Columbia University Medical Center, New York, NY, USA. 2. Department of Neurology, New York University School of Medicine, New York, NY, USA. 3. Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA. 4. Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Department of Neurology, New York-Presbyterian Hospital, New York, NY, USA. 6. Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
Abstract
OBJECTIVE: To determine whether e-mail is a useful mechanism to provide prompt, case-specific data feedback and improve door-to-needle (DTN) time for acute ischemic stroke treated with intravenous tissue plasminogen activator (IV-tPA) in the emergency department (ED) at a high-volume academic stroke center. METHODS: We instituted a quality improvement project at Columbia University Medical Center where clinical details are shared via e-mail with the entire treatment team after every case of IV-tPA administration in the ED. Door-to-needle and component times were compared between the prefeedback (January 2013 to March 2015) and postfeedback intervention (April 2015 to June 2016) periods. RESULTS: A total of 273 cases were included in this analysis, 102 (37%) in the postintervention period. Median door-to-stroke code activation (2 vs 0 minutes, P < .01), door-to-CT Scan (21 vs 18 minutes, P < .01), and DTN (54 vs 49 minutes, P = .17) times were shorter in the postintervention period, although the latter did not reach statistical significance. The proportion of cases with the fastest DTN (≤45 minutes) was higher in the postintervention period (29.2% vs 42.2%, P = .03). CONCLUSION: E-mail is a simple and effective tool to provide rapid feedback and promote interdisciplinary communication to improve acute stroke care in the ED.
OBJECTIVE: To determine whether e-mail is a useful mechanism to provide prompt, case-specific data feedback and improve door-to-needle (DTN) time for acute ischemic stroke treated with intravenous tissue plasminogen activator (IV-tPA) in the emergency department (ED) at a high-volume academic stroke center. METHODS: We instituted a quality improvement project at Columbia University Medical Center where clinical details are shared via e-mail with the entire treatment team after every case of IV-tPA administration in the ED. Door-to-needle and component times were compared between the prefeedback (January 2013 to March 2015) and postfeedback intervention (April 2015 to June 2016) periods. RESULTS: A total of 273 cases were included in this analysis, 102 (37%) in the postintervention period. Median door-to-stroke code activation (2 vs 0 minutes, P < .01), door-to-CT Scan (21 vs 18 minutes, P < .01), and DTN (54 vs 49 minutes, P = .17) times were shorter in the postintervention period, although the latter did not reach statistical significance. The proportion of cases with the fastest DTN (≤45 minutes) was higher in the postintervention period (29.2% vs 42.2%, P = .03). CONCLUSION: E-mail is a simple and effective tool to provide rapid feedback and promote interdisciplinary communication to improve acute stroke care in the ED.
Entities:
Keywords:
education; quality; stroke and cerebrovascular disease; thrombolysis
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