Lean Principles Boost Stroke Treatment Times

A team of stroke clinicians and emergency department staff at Barnes-Jewish Hospital borrowed techniques from the auto industry to give ischemic stroke patients a chance at better outcomes.

In 2010, the team had a median door-to-needle time of 55-65 minutes for patients receiving tPA. By applying “lean” principles, first developed by Japanese car manufacturers to maximize value to customers and reduce waste, in 2011, the team worked to revamp the process and meet their goal of a median time of 30 minutes, says Jennifer Williams, MSN, RN, emergency department clinical nurse specialist.

This was an evidence-based challenge,” says Williams. Data correlate faster door-to-needle times with better outcomes, and the team found that tPA is routinely given within 30 minutes at neurological centers in Europe.

The Barnes-Jewish emergency department’s previous success using lean principles to reduce door-to-needle time for STEMI heart attack patients indicated “lean process improvement is hardwired into the department now,” says Williams.

After mapping out the new process, the group presented to the emergency department staff, EMS personnel and other stroke clinicians, who adopted the changes almost immediately. They basically changed a major process overnight,” Williams says. “And everyone is closely monitoring so that patient safety is not sacrificed for speed.”

As a result, the Barnes-Jewish emergency room stroke team first met the 30-minute goal less than three months after the process change. In the months since, they have sustained a median door-to-needle time just slightly more—37 minutes. While that is significantly under the original time of 55-65 minutes, the team, Williams says, continues to strive toward the goal of a sustained 30-minute median.

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