title: Improving stroke alert response time: applying quality improvement methodology to the inpatient neurologic emergency.
abstract: BACKGROUND
  Stroke often leaves its victims with devastating disabilities if not treated promptly. Guidelines recommend that brain imaging be obtained within 25 minutes, yet this benchmark is rarely achieved for the in-hospital stroke.
  
  
  OBJECTIVE
  To reduce time to evaluation for strokes occurring in patients already hospitalized, through systematic analysis of current processes and application of standardized quality improvement methodology.
  
  
  METHODS
  Improving the quality of care for in-hospital stroke patients involved 4 key steps: (1) creation of a detailed process map to identify inefficiencies in the current process for identifying and treating hospitalized stroke patients, (2) development of an optimized care pathway, (3) implementation of a checklist of optimal practices for the acute stroke response team and nursing staff, and (4) real-time feedback. Time from stroke alert to initiation of computed tomography (CT) scan was prospectively tracked for the 6-month period prior to intervention. After a 3-month interval for intervention roll-out, the response times for the pre-intervention period were compared to a 6-month post-intervention evaluation period.
  
  
  RESULTS
  Pre-intervention median inpatient stroke alert-to-CT time was 69.0 minutes, with 19% meeting the goal of 25 minutes from alert to CT time. Post-intervention median inpatient stroke alert-to-CT time was reduced to 29.5 minutes, with 32% at goal (P < 0.0001).
  
  
  CONCLUSIONS
  This inpatient stroke alert quality improvement initiative decreased median inpatient alert-to-CT time by 57%, and demonstrated that speed of in-hospital stroke evaluation can be improved through systematic application of quality improvement principles.
authors: Departments of Medicine, Neurosurgery, and Neurology, University of Colorado, University of Colorado School of Medicine, Denver CO, USA. Ethan.Cumbler@uc denver.edu
authors: Ethan
authors: E
authors: Cumbler
authors: Rebekah
authors: R
authors: Zaemisch
authors: Alexandra
authors: A
authors: Graves
authors: Kerry
authors: K
authors: Brega
authors: William
authors: W
authors: Jones
mesh_terms: D000368:Aged; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D011930:Reaction Time; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*