Lifesaving speed: Improvement project shaves vital minutes off stroke response

By Patricia Billinger, Front Range Communications Director

When it comes to strokes, every minute matters. Patients have a 5-percent greater chance of in-hospital survival for every 15 minutes shaved off the time it takes for them to receive lifesaving thrombolytics injections, according to the NIH.

The injections re-open arterial circulation in the brain. Hospitals measure how quickly they administer this critical medication in a metric known as DTN, or ‘door to needle’ time. When Good Samaritan experienced a streak of DTN response times that fell short of its goal last year, clinicians launched a process improvement project to bring those response times down. 

The result: In January of this year, the hospital clocked its fastest-ever DTN time at 22 minutes! Prior to launching the improvement project, the fastest time was 27 minutes, in March 2023. 

Thanks to the project, Good Samaritan also kept DTN times under 45 minutes in 100 percent of cases from October 2023 through January 2024 – 25 percent faster than the Joint Commission minimum standard of 60 minutes or faster. The hospital’s 100-percent success rate also elevated its compliance well ahead of the national average during that timeframe, which was about 70 percent.

L to R: Susanne Dyal, PharmD, Wendi Miller, RN, stroke coordinator, Emilie Baney, RN, SSC, charge nurse, Cameron Carnes, ED tech, and Megan Orifici, RN. The machine is called the Tele-Doc camera.

“We have seen continuous improvement in our DTN times this past year, and we’re pleased with how much progress has been made,” said Wendi Miller, RN, BSN, stroke coordinator for Good Samaritan.

What have been the keys to the project’s success so far? 

• Educating EMS and ED staff on how to identify stroke symptoms and call stroke alerts promptly. This included weekly staff meeting discussions and laminated tip sheets in triage rooms. 

• Instructing clinicians to screen for stroke symptoms and call a stroke alert in triage rather than waiting for the patient to go to a room. 

• Tracking every stroke alert that took more than 10 minutes to raise clinicians’ awareness about how much time was elapsing and remind them of the impact of time on stroke patients. 

• Conducting audits and one-on-one coaching sessions to identify barriers and opportunities for education to help recognize stroke patients quicker. 

• Celebrating wins and encouraging friendly competition among staff to reduce DTN times. 

• Enhancing the partnership between Emergency Department RNs, clinicians and pharmacists, who are integral in calculating, preparing and verifying the thrombolytics for IV injection. 

One of the key factors that contributed to Good Samaritan's improvement in its DTN rates was the active role of nurses in the stroke care process.

“We worked on empowering nurses to call a stroke alert,” Miller explained. “Every caregiver is empowered to call an alert without needing to seek permission; it’s better to call too many alerts than to miss one.” 

Ever focused on continuous improvement, Miller describes the project as “still a work in progress.” She’d like to ensure that Good Samaritan can maintain its improved DTN rate and continue to drive those times downward. Good Samaritan is also preparing for the next stroke-related project: improving screening for dysphagia (difficulty swallowing), which can cause pneumonia.  

“Stroke patients are at very high risk of developing aspiration pneumonia, with about 35 percent of stroke patients at risk of dying from pneumonia. By nurses implementing a swallowing screen before anything is administered by mouth, we reduce the risk of pneumonia by 50 percent,” Miller explained.  

Also coming up later this year, the Stroke Alliance and several Peaks hospitals are working to organize a stroke camp for patients, clinicians and caregivers in the mountains in August.