Workflow optimization for ischemic stroke in a community-based stroke center

Abstract BACKGROUND To analyze the effect of specific optimization steps to reduce treatment delays in a non-academic stroke hospital setting. METHODS Ischemic stroke patients treated with IV tPA, endovascular therapy or both were analyzed. Metrics were divided into two periods: pre-optimization period (1 October 2015 to 30 September 2016) and post-optimization period (1 October 2016 to 30 September 2017). Key interventions: (1) pre notification by EMS to ED and stroke team; (2) dividing stroke alert to level 1 (IV/IA candidate) vs. level 2; (3) direct transportation of level 1 patients to brain CT; (4) limitation of non-essentialinterventions; (5) stroke orienter; (6) 24/7 code stroke response by a vascular neurologist; (7) earlier notification of IR team; (8) CT to angiosuite direct transportation for LVO; (9) multidisciplinary monthly meetings to discuss delayed cases. RESULTS A total of 279 patients were identified. No significant differences in any of the patient’s baseline characteristics were documented. Almost all metrics favored the post-optimization period with a remarkable improvement in door to puncture time (64 (IQR 36-86) vs. 47 (IQR 20-62) min, p=0.001). We observed an increased percentage of good clinical outcomes in the post-optimization group (60.1% vs 54.8%, p=0.500). There was an 8.4% increase in patients with good clinical outcome in the post-optimization group when compared with our previously published work. CONCLUSIONS For acute reperfusion therapies, significant reductions in workflow time-frames can be achieved after simple optimization methods in a non-academic community-based hospital.