Regional Learning Collaboratives Produce Rapid and Sustainable Improvements in Stroke Thrombolysis Times.
Reduction in door-to-needle (DTN) times in patients with acute ischemic stroke treated with tissue-type plasminogen activator is associated with improved outcomes. We hypothesized that a learning collaborative would rapidly reduce DTN times at Chicago's primary stroke centers.



We analyzed data from all adult patients with out-of-hospital ischemic stroke hospitalized between January 1, 2010 and March 31, 2015 and who received tissue-type plasminogen activator in the emergency department at 15 primary stroke centers in Chicago and 15 primary stroke centers in St. Louis. We implemented a structured learning collaborative in Chicago in quarter 1 of 2013 that included (1) a quality improvement leader, (2) stroke content expert, (3) multidisciplinary teams from each site, (4) a targeted goal for the program (DTN time <60 minutes in >50% of patients treated with tissue-type plasminogen activator), and (5) face-to-face meetings with on-site visits. We used interrupted time-series analysis to compare the impact of the learning collaborative on DTN times in Chicago pre- and post implementation and also concurrently versus St. Louis. We prespecified adjustment for mode of arrival, emergency medical services prenotification, and onset-to-arrival times. P values less than 0.05 were considered significant. In adjusted analysis, the reduction in DTN time within 1 quarter of implementation was 15.5 minutes (P=0.046) at Chicago sites versus 1.17 minutes at St. Louis sites (P=0.601).



Using a learning collaborative model at Chicago's 15 primary stroke centers, we observed major reductions in DTN times within 1 quarter of implementation. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.
From the Departments of Neurology (S.P.) and Preventive Medicine-Biostatistics (J.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; and American Heart Association/American Stroke Association Midwest Affiliate, Chicago, IL (K.O.N.). sprabhak@nm.org.
Shyam
S
Prabhakaran
From the Departments of Neurology (S.P.) and Preventive Medicine-Biostatistics (J.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; and American Heart Association/American Stroke Association Midwest Affiliate, Chicago, IL (K.O.N.).
Jungwha
J
Lee
From the Departments of Neurology (S.P.) and Preventive Medicine-Biostatistics (J.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; and American Heart Association/American Stroke Association Midwest Affiliate, Chicago, IL (K.O.N.).
Kathleen
K
O'Neill
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002641:Chicago; D003299:Cooperative Behavior; D004502:Education, Medical, Continuing / Q000379:methods; D004509:Education, Nursing, Continuing / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D033183:Interdisciplinary Communication; D007858:Learning; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D008923:Missouri; D009741:Nursing Staff, Hospital / Q000193:education; D010348:Patient Care Team; D010564:Personnel, Hospital / Q000193:education*; D015397:Program Evaluation; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Chicago; emergency medical services; quality improvement; stroke; thrombolysis