Hospitals combine “lean” model and MRI to speed acute stroke treatment

Timing is everything when it comes to emergency stroke response—patients who are treated within 60 minutes of the initial event have significantly improved outcomes. That fact led two Washington, D.C., area hospitals to borrow ideas about “lean” production processes from profit-driven manufacturers to reduce the time interval between arrival and treatment for acute stroke victims, according to a recent study by the National Institutes of Health (NIH) published online May 13 in the journal Neurology.

Before patients who arrive in the ED with stroke can be given the clot-busting drug tPA, they must first undergo an imaging examination to determine their suitability for treatment. The sooner the scan, the faster the patient can be treated. “By making small changes to our processes, we were able to scan suspected stroke patients with MRI and appropriately treat patients within a goal time of 60 minutes. This is an important finding for hospitals, healthcare providers and the public,” said senior author Amie Hsia, MD, of MedStar Washington Hospital Center. “Not only does MRI provide more precise and complete information than the traditionally used CT scan, now we’ve also demonstrated that it is feasible to use from a time perspective.”

Doctors at both Medstar Washington and Suburban Hospital in Bethesda, Md., work closely with NIH researchers to implement new processes and procedures. One such innovation at Suburban Hospital consists of including injections of tPA in medication carts inside MRI rooms so patients could immediately receive them following a successful scan.

“We wanted to share with other hospitals exactly how we streamlined our processes so they could see what’s possible, and consider applying similar interventions within their own institutions, to be able to use MRI scans when needed to quickly guide treatment decisions for patients with suspected stroke,” said Hsia. “Among the efficiency-improving steps taken by the hospitals were creating process maps to identify roadblocks causing delays, reorganizing the work flow to reduce handoffs, and assigning specific roles to each member of the stroke team.”

The study concluded that hospitals can use the time-saving techniques (known as SMART, or Screening with MRI for Accurate and Rapid stroke Treatment) to reduce their “door-to-needle” times and improve overall stroke treatment and outcomes.