Hartnett, Daniel

Starosciak, Amy

Strauss, Jayme

Waisbrot, Andrew

English

Scholarly Commons@Baptist Health South Florida

Baptist Health South FloridaScholarly Commons @ Baptist Health South FloridaAll Publications12-2017The Road to Target: Stroke Honor Roll Elite PlusJayme StraussBaptist Hospital of Miami; Baptist Neuroscience Center, jaymes@baptisthealth.netAndrew WaisbrotBaptist Hospital of Miami, AndrewWa@baptisthealth.netDaniel HartnettBaptist Hospital of Miami, DanielH1@baptisthealth.netAmy StarosciakBaptist Health South Florida, amyst@baptisthealth.netFollow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publicationsThis Conference Poster -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has beenaccepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For moreinformation, please contact Carrief@baptisthealth.net.CitationStrauss, Jayme; Waisbrot, Andrew; Hartnett, Daniel; and Starosciak, Amy, "The Road to Target: Stroke Honor Roll Elite Plus" (2017).All Publications. 2876.https://scholarlycommons.baptisthealth.net/se-all-publications/2876Elevating care through discoveryThe Road to Target: Stroke Honor Roll Elite PlusJayme Strauss, MSN, RN, MBA, SCRN, Andrew Waisbrot, BSN, RN, Daniel Hartnett, MSN, RN, SCRN, Amy K. Starosciak, Ph.D.INTRODUCTIONOne minute of brain ischemia kills 2 million neurons and 14 billionsynapses. Longer treatment times decrease the likelihood of goodfunctional recovery. The American Stroke Association implementedthe Target: Stroke Elite Plus campaign to reduce treatment delaysand improve outcomes. For a center to win this Elite Plus Award,patients must receive IV t-PA within 60 minutes of hospital arrival75% of the time, and treated within 45 minutes 50% of the time.PURPOSEEarly in fiscal year 2015, the Door-To-Needle (D2N) and Door-To-Reperfusion (D2R) times at our comprehensive center rose to 78min and 154 min, respectively. The rate of IV t-PA administration in60 min decreased to 17%. Therefore, the stroke team used leanmethodology (Teams Refocus Imagine Measure; TRIM) to reduceDTN and DTR, improve outcomes, and achieve Elite Plus status.Table 1. Average Door to Needle, Door to Intervention Times METHODSTRIM and Plan-Do-Check-Act methods, value stream mapping, A3problem solving and real-time observations were used to identifybarriers, duplications and wasted time. The following majorchanges were made over the last 2 years:RESULTS (cont’d)Table 2. Average Times before and after the TRIM processFigure 3. 90-d modified Rankin Scale scores before and after TRIM.  A score of 0-2 (blue) is considered good clinical outcome.  Median initial NIHSS was similar at both time points (Before: 12, After: 13).CONCLUSIONSThrough an organized multidisciplinary team approach usingstandardized process improvement methods, identified bestpractices, stroke treatment was faster, we achieved Elite Plus statusfor 2017, and we improved patient outcomes.ACKNOWLEDGMENTSThank you to the Baptist Hospital Stroke TRIM Committee for theirtremendous hard work and persistent pursuit of excellence.RESULTSFigure 1. Average ± SD for D2N (top panels) and percent compliancewith D2N ≤ 60 min (middle panels) or D2N ≤ 45 min (bottompanels). Results before TRIM process was initiated (left panels) andafter TRIM (right panels).Figure 2. Average ± SD for D2G (top panels) and percent compliancewith D2G ≤ 90 min (bottom panels). Results before TRIM processwas initiated (left panels) and after TRIM (right panels).Measurements Target FY14 Oct Nov Dec Jan 15Door to Needle (D2N) time 60 Min 57 min 66 min 53 min 68 min 78 minPercent of patients treated w/t-PA < 60 min>75% 76% 60% 80% 56% 17%Door to Groin <105 min 109 min 139 min 124 min 108 minDoor to Reperfusion (1st Pass) < 120 min 146 min 156 min 165 min 146 min 133 minDoor to Full Reperfusion N/A 175 min 197 min 172 min 154 min• All strokes to Trauma Room 49 • Quick registration • EDP educate on t-PA • Glucose and EKG accepted from EMS • Do not insert Foley • “One page” alert system• Quick bleeding risk checklist • MAC anesthesia approach• No written consent for treatment• D2N goal from 60 to 45 min• t-PA in CT Scan • Security escort to galleryMeasurements Target Before TRIM After TRIMDoor to Needle (D2N) time 45 Min 59 ± 18 min 42 ± 18 minPercent of patients treated w/t-PA < 45 min>50% 27% 73%Door to Groin <90 min 112 ± 36 min 93 ± 45 minDoor to Reperfusion (1st Pass) < 120 min 143 ± 42 min 120 ± 46 minDoor to Full Reperfusion N/A 173 ± 39 min 138 ± 51 min

The Road to Target: Stroke Honor Roll Elite Plus

Baptist Health South FloridaScholarly Commons @ Baptist Health South FloridaAll Publications3-2018The Road to Target: Stroke Honor Roll Elite PlusJayme StraussBaptist Hospital of Miami; Baptist Neuroscience Center, jaymes@baptisthealth.netAndrew WaisbrotBaptist Hospital of Miami, AndrewWa@baptisthealth.netDaniel HartnettBaptist Hospital of Miami, DanielH1@baptisthealth.netAmy StarosciakBaptist Health South Florida, amyst@baptisthealth.netFollow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publicationsThis Conference Poster -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has beenaccepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For moreinformation, please contact Carrief@baptisthealth.net.CitationStrauss, Jayme; Waisbrot, Andrew; Hartnett, Daniel; and Starosciak, Amy, "The Road to Target: Stroke Honor Roll Elite Plus" (2018).All Publications. 2882.https://scholarlycommons.baptisthealth.net/se-all-publications/2882Elevating care through discoveryThe Road to Target: Stroke Honor Roll Elite PlusJayme Strauss, MSN, RN, MBA, SCRN, Andrew Waisbrot, BSN, RN, Daniel Hartnett, MSN, RN, SCRN, Amy K. Starosciak, Ph.D.INTRODUCTIONOne minute of brain ischemia kills 2 million neurons and 14 billionsynapses. Longer treatment times decrease the likelihood of goodfunctional recovery. The American Stroke Association implementedthe Target: Stroke Elite Plus campaign to reduce treatment delaysand improve outcomes. For a center to win this Elite Plus Award,patients must receive IV t-PA within 60 minutes of hospital arrival75% of the time, and treated within 45 minutes 50% of the time.PURPOSEEarly in fiscal year 2015, the Door-To-Needle (D2N) and Door-To-Reperfusion (D2R) times at our comprehensive center rose to 78min and 154 min, respectively. The rate of IV t-PA administration in60 min decreased to 17%. Therefore, the stroke team used leanmethodology (Teams Refocus Imagine Measure; TRIM) to reduceDTN and DTR, improve outcomes, and achieve Elite Plus status.Table 1. Average Door to Needle, Door to Intervention Times METHODSTRIM and Plan-Do-Check-Act methods, value stream mapping, A3problem solving and real-time observations were used to identifybarriers, duplications and wasted time. The following majorchanges were made over the last 2 years:RESULTS (cont’d)Table 2. Average Times before and after the TRIM processFigure 3. 90-d modified Rankin Scale scores before and after TRIM.  A score of 0-2 (blue) is considered good clinical outcome.  Median initial NIHSS was similar at both time points (Before: 12, After: 13).CONCLUSIONSThrough an organized multidisciplinary team approach usingstandardized process improvement methods, identified bestpractices, stroke treatment was faster, we achieved Elite Plus statusfor 2017, and we improved patient outcomes.ACKNOWLEDGMENTSThank you to the Baptist Hospital Stroke TRIM Committee for theirtremendous hard work and persistent pursuit of excellence.RESULTSFigure 1. Average ± SD for D2N (top panels) and percent compliancewith D2N ≤ 60 min (middle panels) or D2N ≤ 45 min (bottompanels). Results before TRIM process was initiated (left panels) andafter TRIM (right panels).Figure 2. Average ± SD for D2G (top panels) and percent compliancewith D2G ≤ 90 min (bottom panels). Results before TRIM processwas initiated (left panels) and after TRIM (right panels).Measurements Target FY14 Oct Nov Dec Jan 15Door to Needle (D2N) time 60 Min 57 min 66 min 53 min 68 min 78 minPercent of patients treated w/t-PA < 60 min>75% 76% 60% 80% 56% 17%Door to Groin <105 min 109 min 139 min 124 min 108 minDoor to Reperfusion (1st Pass) < 120 min 146 min 156 min 165 min 146 min 133 minDoor to Full Reperfusion N/A 175 min 197 min 172 min 154 min• All strokes to Trauma Room 49 • Quick registration • EDP educate on t-PA • Glucose and EKG accepted from EMS • Do not insert Foley • “One page” alert system• Quick bleeding risk checklist • MAC anesthesia approach• No written consent for treatment• D2N goal from 60 to 45 min• t-PA in CT Scan • Security escort to galleryMeasurements Target Before TRIM After TRIMDoor to Needle (D2N) time 45 Min 59 ± 18 min 42 ± 18 minPercent of patients treated w/t-PA < 45 min>50% 27% 73%Door to Groin <90 min 112 ± 36 min 93 ± 45 minDoor to Reperfusion (1st Pass) < 120 min 143 ± 42 min 120 ± 46 minDoor to Full Reperfusion N/A 173 ± 39 min 138 ± 51 min

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The Road to Target: Stroke Honor Roll Elite Plus

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