Identifying delays occurring in out-of-hours FAST calls causing increasing door-to-treatment time

Stroke is one of the leading causes of death and disability worldwide and is a huge economic burden. The management of stroke is time dependant. Shorter times result in reduced mortality and morbidity. National Guidelines in Ireland suggest a door-to-treatment time of one hour or less from presentation to the emergency department. Despite this recommendation, delays are still occurring for patients accessing timely treatment. This quality improvement project was carried out in a busy North Dublin hospital- one of the largest acute stroke centres in Ireland. A total of nine patient journeys were followed and door-to-treatment times were documented over a three-month period. Five of these patients presented out-of-hours and four presented in-hours, whilst a specialised stroke team was on-site. The average door-to-treatment time for a stroke patient presenting out-of-hours was 72 minutes, whereas, the average door-to-treatment time for a stroke presenting in-hours was 54.25 minutes. The DMAIC framework and QI tools guided this project and recommendations were made following data analysis, to meet the aim to reduce door-to-needle times or acute ischaemic stroke patients. These included regular on-site teaching by the stroke team, improving communication with the emergency services to ensure pre-alert to an incoming FAST positive patient and the presence of a stroke crash trolley within the radiology department. Following implementation of these changes, a plan will be put in place to monitor and sustain improvements. This quality improvement plan requires a collaborative team approach to meet the national guidelines in treating this important life-threatening condition.