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O9 Quality improvement through simulated practice: reducing ed door to ct time in potentially thrombolysable stroke patients
  1. I Braithwaite,
  2. F Waterson,
  3. R Alcock,
  4. I Tuck
  1. NHS Forth Valley, UK

Abstract

Introduction With 1.9 million neurons lost every minute a stroke is untreated, rapid assessment and treatment is a time critical medical emergency.

Rapid access to CT imaging is an immediate priority to allow exclusion of patients with haemorrhagic strokes and absolute contraindications to thrombolysis therapy.

Our QI project aimed to reduce time from arrival to CT for patients presenting with potentially thrombolysable stroke.

With simulation becoming increasingly prevalent within medical education our aim was to incorporate simulation as a key process in delivering quantifiable change in practice.

Methods We initially used in situ simulation to live process map the care of a potentially thrombolysable patient through the ED at FVRH. By running a number of simulated scenarios we identified ‘unnecessary’ delays from non-value adding activity and created a new streamlined protocol for this patient group which facilitated rapid assessment, stabilisation and access to CT imaging.

This protocol was rolled out in liaison with the on-site stroke team and PDSA cycles were initiated to enable rapid cycle change. We then used regular in-situ simulation training to train and subsequently continually stress the system.

Results Through the use of our updated patient flow pathways in conjunction with in situ simulation training and education the department door to CT time was reduced by 40%, from 30 minutes (median 23) to 18 minutes (median 13).

Conclusion Use of simulation for process mapping and production of a streamlined protocol for patients presenting with hyper-acute stroke and regular simulation training allows for a net reduction in ‘Time-to-CT’.

This improves patient safety by enabling greater time for appropriately trained and designated staff to decide on treatment and administer thrombolysis therapy more rapidly. It will enable the department to meet the current SCCAG targets of delivering thrombolysis within 30 minutes.

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