Abstract P818: Increased Eligibility for Endovascular Therapy Following Intensive Door-To-Transfer Improvement Project

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Leigh A Creighton ◽  
Brian L Kaiser
Keyword(s):  
Rapid Identification ◽  
Team Development ◽  
Rapid Reduction ◽  
Improvement Project ◽  
Patient Transfers ◽  
Roles And Responsibilities ◽  
Transport Team ◽  
Completed Stroke ◽  
Additional Improvement ◽  
Transfer Times

Background and Purpose: Early EVT for large vessel acute ischemic stroke is associated with reduced disability and mortality. Longer transfer times from the sending facility contribute to poorer EVT outcomes, and in some circumstances, patient ineligibility for EVT due to a completed stroke on arrival to the endovascular site. Reducing avoidable delays will result in overall improved EVT outcomes and reduce the frequency of completed stroke upon arrival. Methods: A multidisciplinary group utilized the Lean A3 process and PDCA improvement cycle to reduce transfer times. Avoidable delays and resources to expedite the transfers were identified. A standardized plan with defined roles and responsibilities, communication pathways, early transport team activation, and robust staff education were implemented. The PI team met weekly for 3 months to review each individual transfer, determine what went well and what did not, and to identify additional improvement opportunities. A weekly summary with feedback was provided to front line staff and managers. Staff involved in patient transfers that had a DIDO of 90 min or less were recognized with a “Brain Pin” and staff recognition certificate. Results: Since its implementation, 23 patients were transferred for potential EVT. Compared with 12 months prior to implementation, the DIDO median time was reduced from 119 minutes to 80.5 minutes, transfers were achieved in 90 min or less 61% (n=15) of the time vs. 27.2%, and percentage of EVT eligible patients increased from 58.3 to 78.3%. Conclusion: In conclusion, rapid reduction of DIDO times and increased patient eligibility for thrombectomy is attainable through an intensive multidisciplinary process improvement project. Implementing a standardized workflow that includes rapid identification of potential EVT transfers, early activation of the transport team, development of clear pathways of communication, defined roles and responsibilities within the team, and regular staff feedback are essential.

Rural Trauma Team Development Course Decreases Transfer Times

2015 ◽  
Vol 221 (4) ◽  
pp. S135
Author(s):  
Vicente J. Undurraga Perl ◽  
Bruce Ham ◽  
Amy Laird ◽  
Richard J. Mullins ◽  
Brian S. Diggs ◽  
...  
Keyword(s):  
Trauma Team ◽  
Team Development ◽  
Development Course ◽  
Transfer Times

scholarly journals 16 An Analysis of the Impact of Establishing an Ambulatory Stroke Team

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Colin Menagh ◽  
David Wilson ◽  
Kevin Dynan ◽  
Michael Power ◽  
Karen Hull ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Stroke Unit ◽  
Hospital Admissions ◽  
Early Discharge ◽  
Rapid Identification ◽  
Improvement Project ◽  
Stroke Mimics ◽  
Stroke Team ◽  
Bed Days ◽  
The Impact

Abstract Background The South Eastern Trust established an Ambulatory Stroke Team (AST) in October 2017. This consisted of Stroke Nurses and a Specialty doctor with Stroke consultant support. During the initial pilot the AST team worked Monday – Friday 9-5pm. The majority of assessments took place in the emergency department. The overall aims were to improve length of stay for TIAs / stroke mimics and improve the percentage of strokes being admitted directly to the Stroke Unit. Methods Using quality improvement methodology we worked through several Plan, Do, Study, Act (PDSA) cycles. The most significant intervention was the introduction of a protected direct to stroke unit bed. A database was kept of all patients seen, including final diagnoses and patients discharged after assessment, preventing admission and saving bed days. Results A 6 month period was analysed from April to September 2018. 312 patients were reviewed - 159 (51%) stroke mimics, 108 (35%) strokes and 45 (14%) TIAs. 54 patients were identified for early discharge and appropriate follow-up. Bed days saved was estimated at 110 days. Direct to stroke unit percentage improved from 30% in October 2017 when the AST was introduced to 82% in January 2019. Conclusion A dedicated Ambulatory Stroke Team can prevent hospital admissions and save bed days due to rapid identification and specialist assessment of suspected TIAs and strokes. Multidisciplinary team working as part of a quality improvement project can improve the percentage of strokes admitted directly to the stroke unit.

Use of SEM, X-ray analysis and TEM to localize Fe3+ reduction in roots

1988 ◽  
Vol 46 ◽  
pp. 392-393 ◽  
Author(s):  
William P. Wergin ◽  
P. F. Bell ◽  
Rufus L. Chaney
Keyword(s):  
Electron Microscopy ◽  
Root Hairs ◽  
Rapid Reduction ◽  
X Ray ◽  
Physical Evidence ◽  
Transmission Electron ◽  
Young Root ◽  
Insoluble Precipitate ◽  
Uptake And Transport ◽  
Scanning Electron

In dicotyledons, Fe3+ must be reduced to Fe2+ before uptake and transport of this essential macronutrient can occur. Ambler et al demonstrated that reduction along the root could be observed by the formation of a stain, Prussian blue (PB), Fe4 [Fe(CN)6]3 n H2O (where n = 14-16). This stain, which is an insoluble precipitate, forms at the reduction site when the nutrient solution contains Fe3+ and ferricyanide. In 1972, Chaney et al proposed a model which suggested that the Fe3+ reduction site occurred outside the cell membrane; however, no physical evidence to support the model was presented at that time. A more recent study using the PB stain indicates that rapid reduction of Fe3+ occurs in a region of the root containing young root hairs. Furthermore the most pronounced activity occurs in plants that are deficient in Fe. To more precisely localize the site of Fe3+ reduction, scanning electron microscopy (SEM), x-ray analysis, and transmission electron microscopy (TEM) were utilized to examine the distribution of the PB precipitate that was induced to form in roots.

Success Strategies: Implementing the Professional Performance Review Process for School-Based Speech-Language Pathologists

2009 ◽  
Vol 19 (1) ◽  
pp. 4-9
Author(s):  
Jill Parmenter ◽  
Sheryl Amaral ◽  
Julia Jackson
Keyword(s):  
Review Process ◽  
Successful Implementation ◽  
Speech Language Pathologists ◽  
Self Advocacy ◽  
Professional Performance ◽  
Performance Review ◽  
Roles And Responsibilities ◽  
Speech Language Pathologist ◽  
School Based ◽  
Review Management

Abstract The Professional Performance Review Process for School-Based Speech-Language Pathologists (PPRP) (ASHA, 2006) was developed in response to the need for a performance review tool that fits school district requirements for performance review management while addressing the specific roles and responsibilities of a school-based speech-language pathologist (ASHA, 2006). This article will examine the purpose and components of the PPRP. A description of its use as a tool for self-advocacy will be discussed. Strategies for successful implementation of the PPRP will be explained using insight from speech-language pathologists and other professionals familiar with the PPRP.

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