Abstract TP112: Achieving 30 Minute Median Door to Needle Time at an Urban Center Using Telemedicine

Introduction: We constantly strive to improve outcomes for stroke patients. Current ASA Guidelines recommend a door to needle (DTN) time of 60 minutes or less, with a secondary goal DTN time of 45 minutes or less. Our goal was to decrease IV Alteplase (tPA) DTN times to 30 minutes or less using primarily Telemedicine. Methods: In February of 2017, significant changes were made to our stroke alert process:Solidified process for direct neurology beam into the Telemedicine camera (rather than phoning first)Pharmacy responds to stroke alerts in person, and pre-mixes (if the neurologist deems appropriate) tPA at the bedsideThe Teleneurologist remains on the camera, which accompanies the patient to CAT Scan (CT). Through the camera, the neurologist reads the head CT in real timeIf no hemorrhage is confirmed on the CT scan, a verbal order to administer tPA is given while in the CT suite Challenges: Staff concern for patient safety, staff matrices, time constraints to implement these changes, our stroke committee collaborated with all affected departments. Resources were created including checklists and a Stroke Kit that contains tPA mixing guidelines, dosing charts, and blood pressure medications. The staff and physicians were educated on the new process via multiple venues including mock stroke alerts Summary: From 2016 to 2017, there was a significant increase in the percentage of stroke patients who received tPA within 45 minutes or less, and within 30 minutes or less. There were no symptomatic hemorrhages post tPA administration in either 2016 or 2017.Our median DTN time decreased by 11 minutes 8 months after the implementations discussed (from 41 minutes in 2016 to 30 minutes in 2017). Many individual DTN times were under 30 minutes.Because of our success, these process changes were adapted by sister facilities within our division.Our stroke alert process is an excellent example of staff interdisciplinary collaboration, open mindedness, flexibility, enthusiasm and knowledge.