The earlier stroke thrombolytic therapy is given in acute ischaemic stroke the better the functional outcomes for the patient. 'Door to needle time' is an important key performance measure.
The Acute Stroke Service in the Mater Hospital developed a new streamlined stroke thrombolysis pathway aiming to shorten door to needle time for acute stroke thrombolysis in December 2013. The Project to develop this pathway, which is called ‘Door to Needle’ (DTN) was originally established by Professor Sean Murphy and a multidisciplinary team, both internal and external, with the goal to reduce the median Door to Needle time for Acute Ischemic Stroke patients attending the Mater Hospital Emergency Department from 80 minutes to 60 minutes. With the support of Prof Mary Day CEO Mater Hospital and Prof Conor O'Keane, it was agreed that the Project at the Mater should be supported by the Mater Lean Academy. The Mater Lean Academy was delighted to take the Lean Six Sigma helm of the Mater Lean ‘Door to Needle’ Project from March 2014 onwards and to support Professor Murphy, the Acute Stroke team and the frontline staff in supplying Lean Six Sigma guidance and support. The Project is now in the Control Phase.
Key new and enhanced features in this updated pathway include the following:
Since baseline readings in December 2013 there has been a corresponding drop in median Door to needle time from 80 minutes to 45 minutes, an improvement of 44% in the thrombolysis administration time. Correspondingly, the median Door to CT time has decreased from 47 to 15 minutes, an improvement of 66% in the door to CT. These early indicators illustrate that this new pathway has made a big impact in expediting the acute initial assessment off suspected stroke patients in the Mater Emergency Department.
The Mater Lean Academy is delighted to have supported front Line staff in their continued consolidation of this Project since March 2014, and to have many of its Green Belt graduates directly involved in the Project Implementation. At the end of the day, the Project reflects the Mater ethos of Person Centred Care.
“The enormous amount of work that was required and huge number of stakeholders that were consulted and encouraged to change the way they do things, took time, dedication, and energy by the whole team.” – Prof. Sean Murphy, The Mater Misericordiae University Hospital