Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Jun 2018)

Reducing Door-to-Reperfusion Time for Mechanical Thrombectomy With a Multitiered Notification System for Acute Ischemic Stroke

  • Eric D. Goldstein, MD,
  • Lynda Schnusenberg, MBA,
  • Lesia Mooney, MSN, RN, ACNS-BC,
  • Carol C. Raper, BS, RHIA,
  • Sheila McDaniel, BSN, RN-BC,
  • Dallas A. Thorpe, RT,
  • Michelle T. Franke,
  • Linda K. Anderson, ARNP-CRNA,
  • Lynnae L. McClure, RT,
  • Misty M. Oglesby, RN, NE-BC,
  • Catina Y. Lewis, RN,
  • Cammi Velichko, MSN, RN, NE-BC,
  • Belinda G. Bradley, ARNP,
  • William W. Horn, Jr., ARNP,
  • Ashley N. Reid, RN,
  • Jason L. Siegel, MD,
  • Rocco Cannistraro, MD,
  • Perry Bechtle, DO,
  • Maria Thereza Barbosa, MD,
  • Scott M. Silvers, MD,
  • Benjamin L. Brown, MD,
  • William D. Freeman, MD,
  • David A. Miller, MD,
  • Kevin M. Barrett, MD, MSc,
  • Josephine F. Huang, MD

Journal volume & issue
Vol. 2, no. 2
pp. 119 – 128

Abstract

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Objective: To reduce door-to-angiographic reperfusion (DTR) time to 120 minutes for patients presenting with acute ischemic stroke attributed to anterior circulation large-vessel occlusion amenable to endovascular mechanical thrombectomy. Patients and Methods: Patients treated with mechanical thrombectomy before (April 10, 2015, through April 11, 2016) and after (April 12, 2016, through May 10, 2017) implementation of a multitiered notification system were studied. Lean process mapping was used to assess inefficiencies with multidisciplinary triage. A 3-tiered paging platform, which rapidly alerts essential personnel of the acute ischemic stroke team at advancing decision points, was introduced. Results: Sixty-two patients were analyzed before and after implementation (34 vs 28, respectively). Following intervention, DTR time was reduced by 43 minutes (mean DTR, 170 minutes vs 127 minutes; P=.02). At 90-day follow up, 5 of the 28 patients in the postintervention cohort (19%) had excellent neurologic outcomes, defined as a modified Rankin Scale score of 0, compared to 0 of 34 (0%) in the preintervention cohort (P=.89). Reductions were also seen in the length of stay on the neurocritical care service (mean, 6 vs 3 days; P=.006), and total hospital charges for combined groups (mean, $100,083 vs $161,458; P<.001). Conclusion: The multitiered notification system was a feasible solution for improving DTR within our institution, resulting in reductions of overall DTR time, neurocritical care service length of stay, and total hospital charges.