Northwick Park Hospital

Clinical challenge
To ensure thrombolysis door to needle times are as low as possible and to maintain these times consistently to maximise clinical efficacy, while ensuring that safety is not compromised.

Solution
QI methods used for the project:

• Introduction in 2011 of an on-going audit looking at thrombolysis door-to-needle times.
• The process was broken down into its constituent parts:
  • Patient arrival time.
  • Time stroke nurse arrives.
  • Time of call to stroke doctor.
  • Time doctor arrives.
  • Time CT scan requested.
  • Time CT scan done.
  • Time CT scan reported.
  • Time of thrombolysis.
• Identification of “bottle necks” in the process.
• Every case analysed in a monthly audit meeting to address any delays and reflect on good practice.
• Any delay fed-back to individuals and all staff involved continually trained, including A&E staff and radiology registrars.
• Introduction of an Excel spreadsheet to continuously analyse steps in the process.
• Analysis of any complications to thrombolysis

Impact
DTNs were low, but improved further and have been consistent.

Reflection

• The project was simple and effective, but labour-intensive and continual.
• Similar granular analysis of the process for patients referred for thrombectomy to be carried out to monitor and improve these times.