Improving Door-To-Decision Time for Patients on Warfarin Presenting With Acute Ischaemic Stroke

Stroke is a leading cause of disability and death in Ireland, and a vital component in the management of stroke is a timely response. Recommendations have been made to achieve door-to-treatment times of less than 60 minutes. A public hospital in Dublin experienced delays in this process, particularly in regard to the attainment of International Normalised Ratio blood results for patients on Warfarin. Of the seven patients on Warfarin who presented during a four-month period, none received thrombolysis therapy, with an average of 88 minutes wait for availability of International Normalised Ratio results. Through guidance from the Lean Six Sigma model and the use of multiple quality improvement tools, a plan was made to reduce door-to-decision times for Warfarin patients presenting with an acute ischaemic stroke, through implementation of two improvements. The first is to notify the laboratory of the urgency of these results, and the second is the hand delivery of the samples to the laboratory. The aim is to reduce the time it takes to receive these blood results to less than 45 minutes. Following implementation, continuous evaluation will be imperative to drive and maintain the improvement.