Abstract WP83: Improving Care Delivery Times in a Prehospital Mobile Stroke Unit Setting

Background: Stroke centers across the country followadhere to established best practice timeframes for stroke care delivery, such as door-to-doctor, door-to-CT, and door-to-needle times. Mobile Stroke Units (MSUs) represent offer a novel approach to stroke care, and there are currently no established, agreed upon, standards for time metric goals. This study is aimedaims at to establishing MSU time metrics and implementing strategies to improve the efficiency of prehospital stroke care.

Methods: We analyzed data from 289 patients admitted to the MSU between the years of 2017-2023. Key metrics were identified and analyzed, including alarm-to-dispatch time, on-scene-to-MSU evaluation time, admission-to-lab time, admission-to-CT non-contrast start time, CT non-contrast end-to-interpretation time, admission-to-thrombolysis/hemorrhage reversal/antihypertensive treatment time, and on-scene duration.

From these metrics, goal times were established for the MSU program. These goals were shared with the MSU staff, who identified modifiable and non-modifiable factors affecting each metric. The team implemented action items to improve the metrics. A debriefing form was introduced, enabling staff to review metrics post-care, document whether goal times were met, and identify barriers and successes. Monthly reviews were conducted to monitor progress and refine practices.

Results: Between January-July 2024, 31 MSU patients were treated, and the established metrics were analyzed and evaluated. Notable improvements were observed in five key areas: Alarm-to-dispatch time improved by 54% (.45 mins), on-scene-to-evaluation time improved by 48% (1.54 mins), admission-to-lab time improved by 23% (2.84 mins), admission-to-CT non-contrast start time improved by 44% (3.94 mins), on-scene duration improved by 13% (6.16 mins).

These improvements highlight the potential for significant enhancement in time-sensitive stroke care delivery through the active implementation of quality improvement action plans by the MSU team.

Conclusions: Setting and adhering to goal time metrics similar to those practiced in hospital-based stroke centers can greatly enhance the performance and care delivery of MSUs. These goal times offer measurable benchmarks to evaluate team performance, allowing for modifications in practice that can further reduce care delivery times. Implementing such improvements is crucial for optimizing patient outcomes in the prehospital stroke care setting.