Auto Industry Techniques Reduce
Door-To-Needle Times

Washington University and Barnes-Jewish stroke team staff borrowed techniques from the auto industry to give acute stroke patients at Barnes- Jewish Hospital the chance at better outcomes.

The speed with which the clot-busting drug tPA is administered after the onset of symptom has long been correlated to better outcome. In 2010, the median time for stroke patients to receive tPA was 55 to 60 minutes from arrival in the Barnes-Jewish emergency department—one of the fastest times in the United States.

But the emergency department stroke team wanted to improve on that.

By applying “lean” principles, such as value stream analysis, first developed by Japanese car manufacturers to maximize value to customers and reduce waste, the team worked to revamp the stroke treatment process, says Jennifer Williams, RN, MSN, emergency department clinical nurse specialist.

Last year, a team that included stroke clinicians and front-line emergency department personnel met for a three-day rapid improvement event (RIE) to map out ways to make the process faster.

Resulting changes included having emergency transport personnel take patients directly to the CT scanner as soon as they arrived at Barnes- Jewish, and having the treatment team “huddle” in the CT area for a face-to-face exchange of information, Williams says.

As a result, in the months since the RiE, the Barnes-Jewish emergency department stroke team has sustained a median door-to-needle time just slightly over 39 minutes.

The team’s next goal, says Williams, will be to sustain a 30-minute median—among the fastest sustained door-to-needle times in the world.