Abstract 16226: A Work-sampling Study to Value Stream Map the Door to Groin Process With Magnetic Resonance Imaging Reduces the Door to Revascularization (D2R) Times in Major Acute Ischemic Stroke (AIS)

• Published in: Circulation (New York, N.Y.) Vol. 132; no. Suppl_3 Suppl 3; p. A16226
• Main Authors: Barnett, Addison E, Singer, Justin, Ray, Abhishek, Fussner, Julie, Tarr, Robert
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 10-11-2015
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.16226

IntroductionNeurologic recovery following revascularization procedures for major AIS are dependent on the speed and adequacy of reperfusion but core infarct volume predicts the risk of intracranial hemorrhage and malignant edema. MR diffusion-weighted imaging is far more sensitive and reliable than CT in depicting the core infarct but few stroke centers use this for urgent decision-making due to time delays and challenges for patient monitoring.HypothesisA work-sampling analysis could quickly identify opportunities to reduce D2R times that incorporate sensitive but time consuming neuroimaging.MethodsThe Lean A3 process defined the current and a future state of AIS patient throughput. Over 2 weeks, a work-sampling study was conducted to identify sources of wasted time that were attributed to manpower, materials, measurement, treatment plan, communication and throughput through a root cause analysis. Cycle time data was collected on all major AIS patients transferred for treatment.ResultsStructured interviews were conducted with 14 providers and an extensive task analysis obtained by observing 5 AIS patients. Resulting process improvements included 1) Pre-hospital completion of MR safety checklist, pre-registration, and standardization of data paged to team, 2) BAT Leader to delegate tasks and monitor time, guided by a customized flow sheet, 3) Streamlined evaluation and transport with MR-compatible monitors, 4) Strategic investments in travelling RN, MR-compatible IV pump, remote imaging access for consensus decisions. D2R time was reduced by 14% (27 min) from Baseline (191 min, n=20), after implementation of a BAT Neuroimaging Algorithm (178 min, n=14), and after throughput efficiencies (164 min, n=6).ConclusionsWork-sampling studies can rapidly improve D2R times in AIS. Efficiency is critical to offset time delays when using MR for safe patient selection; this becomes increasingly important when brain ischemia is prolonged or unknown.