Abstract DP212: Improving Stroke Treatment Times in a Rural Missouri Hospital with Get With The Guidelines®-Stroke

Background: MDMC is a 144-bed large rural hospital, with 17 Emergency Department (ED) beds, located in rural Sikeston (Scott County), MO. The 2010-2020 Heart Disease and Stroke 35+ Age Adjusted Death Rate per 100,000 for Scott County, MO is 511.7, which is significantly higher than the state median at 442.05/100,000, driving MDMC to take action. MDMC is a designated Level III Stroke Center and participates in Get With The Guidelines®(GWTG)-Stroke via American Heart Association’s Rural Health Care Outcomes Accelerator Program to improve emergency department (ED) throughput and time to definitive treatment for the suspected stroke patients. Purpose: MDMC identified a need to improve Door-to-Thrombolytic Therapy and Door-In-Door-Out (DIDO ) times for suspected acute ischemic stroke (AIS). Timely Thrombolytic administration can significantly improve outcomes, making door-to-needle (DTN) a critical quality metric in stroke care. Methods: MDMC assembled a multidisciplinary team to evaluate and streamline processes related to Thrombolytic administration and inter-facility transfer. The team included the ED Director, ED physicians, Stroke Medical Director, nursing, radiology, registration, emergency medical services (EMS), and air medical providers. Collaborative efforts focused on protocol adjustments, workflow optimization, new CT scanner construction, and targeted education to reduce delays and enhance stroke care delivery. Using multiple quality improvement techniques, ED throughput processes were updated, and implementation began in August 2023. In addition to the processes multidisciplinary education was provided for hospital staff and EMS. Results: Prior to its installation, the median DTN time was 60 minutes and the median DIDO time was 108 minutes . After the new CT became operational in October 2024, the average DTN time decreased to 31 minutes , and the median DIDO time improved to 79 minutes . These combined efforts resulted in improvement of 48% improvement for DTN and a 27% for DIDO. Despite multiple process enhancements, no intervention has proven more impactful than proximity to imaging. Post-implementation compliance with AHA benchmarks reached 100% for DTN and 75% for DIDO. Conclusion: Since implementation, each individual intervention led to statistically significant improvements; however, the construction of a new CT scanner in the Emergency Department had the greatest impact on improving DTN and DIDO times.