Norton hospitals beat national door-to-needle times in stroke

Norton Healthcare hospitals achieved a door-to-needle time of 60 minutes or less 89 percent of the time, and less than 45 minutes 58 percent  of the time, compared with the national average of 66 percent and 40 percent, respectively.

When it comes to treating stroke patients, there’s a saying: “Time saved is brain saved.”

“For every minute you do not treat a stroke, you lose 2 million brain cells,” said Lynn Hundley, APRN, director, Clinical Effectiveness and Stroke Care.

Hundley has worked to bring down the door-to-needle time at Norton Healthcare hospitals. That’s the time from when an ischemic stroke patient reaches the hospital to receiving the clot-busting drug tPA.

In 2010, the American Heart Association and American Stroke Association began setting goals for hospitals to reduce the door-to-needle time for stroke patients. They set a primary target of treating 50 percent of eligible patients in 60 minutes or less, and a secondary target of 50 percent in 45 minutes or less.

Norton Healthcare hospitals far exceed both goals, achieving a door-to-needle time of 60 minutes or less 89 percent of the time, and less than 45 minutes 58 percent  of the time, compared with the national average of 66 percent and 40 percent, respectively.

“For every minute, you give back one month of functional recovery,” Hundley said. “It makes a huge difference in patient outcome.

There’s less disability, and stroke is the No. 1 cause of disability in the United States.”

When Hundley began her  work at Norton Healthcare in 2011, the median door-to-needle time was 88 minutes. It’s now 44 minutes (15 minutes faster than the national average).

To make that improvement, Hundley undertook a performance improvement project involving all four adult-service emergency departments. A team examined all the stroke cases treated and how much time each step of the process took. It then looked for ways for them to become more efficient.

Reducing the door-to-needle time begins with emergency medical services (EMS) before the patient reaches the hospital.

Lacy A. Keith, coordinator, Stroke Program Outreach, works with EMS to make sure it gets a detailed history, including when the patient was last known well – a critical piece of information needed before tPA can be administered.

She also trains EMS personnel to call emergency departments en route to alert them a stroke patient is on the way.

This allows hospitals to make sure computed tomography (CT) is ready and the stroke team is waiting. A CT scan does not diagnose ischemic stroke but can rule out hemorrhagic stroke. The drug tPA is not indicated for hemorrhagic stroke.

The focus on door-to-needle time has paid off with some astonishingly fast times.

Norton Brownsboro Hospital holds the record of 12 minutes, eclipsing Norton Hospital’s 14-minute record. Hundley gives a trophy to the emergency department with the best door-to-needle time.

“Much of the time-saving has come from having emergency physicians consult with neurologists by phone if one is not in the hospital,”

Hundley said. “The neurologist will make the call to prescribe tPA or not, and the emergency physician will administer the drug. This collaboration has made a huge difference.”

Hundley rewards doctors and nurses whose door-to-needle time is less than 45 minutes by giving them a pin in the shape of a brain that says, “Time is brain. I saved one.”

“I’m having a hard time keeping the pins in stock now,” Hundley said. “And that is a good thing for our patients!”

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