title: CODE FAST: a quality improvement initiative to reduce door-to-needle times.
abstract: BACKGROUND
  Rapid delivery of IV tissue plasminogen activator (tPA) in qualifying patients leads to better clinical outcomes. The American Heart Association has reduced target door-to-needle (DTN) times from 60 to 45 min in the hopes of continued process improvements across institutions.
  
  
  OBJECTIVE
  To start a quality improvement project called CODE FAST in order to reduce DTN times at our institution.
  
  
  METHODS
  We retrospectively reviewed data from our internally maintained database of patients treated with intravenous tPA before and after implementation of the CODE FAST protocol. We assessed demographic information, time of day and times of arrival to first image and delivery of tPA in patients from February 2014 to February 2015. Outcomes were assessed based on discharge to home. Univariate analysis was performed to assess for improvement in DTN times before and after implementation of the protocol.
  
  
  RESULTS
  A total of 93 patients (41 pre-CODE FAST and 52 post-CODE FAST) received IV tPA during the study period. Patients were equally matched between the two groups except that in the pre-CODE FAST era patients receiving tPA were younger and more likely to be men. There was a substantial reduction in door-to-imaging time from a median of 16 to 8 min (p<0.0001) and DTN time with a reduction in the median from 62 to 25 min (p<0.0001). In logistic regression modeling, there was a trend towards more discharges to home in patients treated during the CODE FAST era.
  
  
  CONCLUSIONS
  We present a quality improvement project that has been overwhelmingly successful in reducing DTN time to <30 min. The template we present may be helpful to other institutions looking to reduce their DTN times and may also reduce costs as we note a trend towards more discharges to home.
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Busby
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Owada
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Samish
authors.initials: S
authors.lastname: Dhungana
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Zimmermann
authors.affiliation: Department of Emergency Medicine, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Coppola
authors.affiliation: Department of Emergency Medicine, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ruban
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Horn
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Dustin
authors.initials: D
authors.lastname: Rochestie
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Khaldi
authors.affiliation: Marietta Neurology and Headache Center, Marietta, Georgia, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hormes
authors.affiliation: Wellstar Medical Group Neurosurgery, Kennestone Hospital, Marietta, Georgia, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D010351:Patient Discharge / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods* / Q000706:statistics & numerical data; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; Thrombolysis