Barnes-Jewish Hospital applies lean methodology to acute stroke care, maximizing resources and slashing door-to-needle times.

To improve door-to-needle times for stroke victims, a multidisciplinary team at Barnes-Jewish Hospital in St. Louis, MO, used lean methodology to identify opportunities for improvement and implement changes aimed at streamlining the care process. As a result, since first implemented in February 2011, average door-to-needle times have improved by nearly 40%, and the number of patients treated within 60 minutes has increased from 52% to 78%. To accelerate care, pre-hospital providers are now empowered to activate the hospital's stroke team from the field. Also, potential stroke victims are brought directly to the hospital's CT scanners rather than the typical entry point in the ED. While patients are at the CT scanner, all the stroke team members assemble to assess the patient and ask critical questions so that all information is shared up front with all the clinicians at the same time. This replaces a process that relied more on serial processing, in which patients would see clinicians more on a one-on-one basis The ED introduced point-of-care testing for PT/INR.The move has enabled clinicians to get test results within 10 minutes rather than 40 minutes. This facilitates quicker decisions on the use of thrombolytic drugs.