Stroke is the fifth leading cause of death and the leading cause of long-term disability in the United States, and timely administration of tissue plasminogen activator (alteplase) is a key predictor of post-stroke survival and disability. The authors explain how a process improvement team utilized LEAN methodology to decrease alteplase administration (“door to needle”) time by almost 50% at a busy, high-acuity hospital emergency room in Houston, Texas. The authors will explain the process that was followed, the post-implementation results, and lessons learned.
FonarowGZhaoXSmithE, et al.Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2014;311(16):1632–1640. doi:10.1001/jama.2014.3203.
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NowakMPfaffHKarbachU. Does value stream mapping affect the structure, process, and outcome quality in care facilities? A systematic review. Syst Rev. 2014;6(1):170. doi:10.1186/s13643-017-0563-y.
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SaverJ. Time is brain—quantified. Stroke. 2005;37(1):263–266.
