A Resident-driven Intervention To Decrease Door-to-needle Time And Increase Resident Satisfaction In A Resource-limited Setting (S14.006)

Objective: To assess whether a resident-initiated multidisciplinary approach to acute stroke management could increase resident satisfaction and decrease door-to-needle (DTN) time in a resource-limited setting. Background: Burnout has been identified as a concern for neurology residents. Their role as first-line responders in stroke codes may contribute to this. The role of neurology residents in initiating stroke systems changes is not well established. At a large, resource-limited public hospital, neurology residents developed a protocol for acute stroke codes focused on improved interdisciplinary communication. Design/Methods: Process mapping was used to identify current state deficiencies. Role redundancy and poor interdisciplinary communication were identified as core deficiencies. Ideal and future state maps were used to create a stroke code workflow diagram (the “protocol”). The protocol was implemented in May 2016. Median DTN times were compared in the pre-intervention (January 1, 2014 – April 30, 2016) and post-intervention (May 1, 2016 – June 15, 2017) periods using non-parametric tests. Resident satisfaction with communication during stroke codes was measured using pre- and post-intervention surveys; responses were compared with t-test. Results: A total of 66 patients received tPA, 20 (30%) in the post-intervention period. Baseline demographics and NIHSS did not differ in the pre- and post-intervention periods. Median DTN decreased (58 vs. 40 min, p=0.02) and proportion of DTN ≤45 minutes doubled (30% vs. 60%, p=0.03). Twenty-three residents (79%) completed pre-intervention surveys; 19 residents (64%) completed post-intervention surveys. Resident satisfaction was greater in the post-intervention period with respect to stroke team communication (2.8 vs. 3.6, p=0.01), understanding multidisciplinary roles (3.8 vs. 4.3, p=0.03), and interaction between team members (3.2 vs. 3.8, p=0.03) measured using a five-point scale (higher being better). Conclusions: In a resource-limited setting, neurology residents are capable of implementing acute stroke workflow changes using basic process improvement methods that have a measurable impact on DTN and resident satisfaction. Disclosure: Dr. Lloyd-Smith Sequeira has nothing to disclose. Dr. Fara has nothing to disclose. Dr. McMenamy has nothing to disclose. Dr. Chan has nothing to disclose. Dr. Ishida has nothing to disclose. Dr. Torres has nothing to disclose. Dr. Zhang has nothing to disclose. Dr. Favate has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Zhou has nothing to disclose. Dr. Rostanski has nothing to disclose.