title: Implementation of an institution-wide acute stroke algorithm: Improving stroke quality metrics.
abstract: In May 2012, an updated stroke algorithm was implemented at Vanderbilt University Medical Center. The current study objectives were to: (1) describe the process of implementing a new stroke algorithm and (2) compare pre- and post-algorithm quality improvement (QI) metrics, specificaly door to computed tomography time (DTCT), door to neurology time (DTN), and door to tPA administration time (DTT).
  
  
  
  Our institutional stroke algorithm underwent extensive revision, with a focus on removing variability, streamlining care, and improving time delays. The updated stroke algorithm was implemented in May 2012. Three primary stroke QI metrics were evaluated over four separate 3-month time points, one pre- and three post-algorithm periods.
  
  
  
  The following data points improved after algorithm implementation: average DTCT decreased from 39.9 to 12.8 min (P< 0.001); average DTN decreased from 34.1 to 8.2 min (P≤ 0.001), and average DTT decreased from 62.5 to 43.5 min (P= 0.17).
  
  
  
  A new stroke protocol that prioritized neurointervention at our institution resulted in significant lowering in the DTCT and DTN, with a nonsignificant improvement in DTT.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Magarik
authors.affiliation: Vanderbilt Comprehensive Stroke Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Kiersten B
authors.initials: KB
authors.lastname: Espaillat
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Nishant
authors.initials: N
authors.lastname: Ganesh Kumar
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Ritwik
authors.initials: R
authors.lastname: Bhatia
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Dewan
authors.affiliation: Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Morone
authors.affiliation: Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Hermann
authors.affiliation: Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: O'Duffy
authors.affiliation: Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Riebau
authors.affiliation: Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Kirshner
authors.affiliation: Department of Neurosurgery, Mt. Sinai School of Medicine, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
keywords: Algorithm; emergency medicine; neurology; neurosurgery; stroke; thrombectomy