Time is critical when treating stroke patients. That’s why efficiency processes, successfully implemented by MedStar Washington Hospital Center’s Comprehensive Stroke Center, can be lifesavers.

The medical team found by streamlining the workflow, they could reduce “door-to-needle” times for stroke patients from 93 to 55 minutes while still using MRI as first-line brain imaging. That 40 percent difference meets the national benchmark for treating stroke patients within an hour.

“We borrowed ideas from manufacturers who use ‘lean’ processes to make their plants more efficient and applied them to health care.”

The goal is to give stroke patients an injection of clot-busting drug, IV tPA. But before patients can get the drug, they must have a CT or MRI scan, to see if they’re suitable candidates for the medicine.

MRIs provide more information than CT scans, like stroke location and size, extent of blood vessel blockage and brain tissue at risk. But MRIs take longer than CT scans and have not been traditionally used in emergency evaluation, so few hospitals use them as first-line brain imaging for acute stroke.

A SMART Approach

What if more hospitals could use MRIs for first-line brain imaging?

That’s the basis of the Screening with MRI for Accurate and Rapid stroke Treatment (SMART) study, performed with the support of the National Institute of Neurological Disorders and Stroke, which concludes that streamlined teamwork among medical staff from doctors and nurses to radiology and lab staff can help patients get MRIs and the best possible care under a tight deadline.

“We borrowed ideas from manufacturers who use ‘lean’ production processes to make their plants more efficient, and applied them to healthcare,” says the study’s senior author, Dr. Amie Hsia, medical director of the Comprehensive Stroke Center at MedStar Washington Hospital Center.

Efficiency-improving steps include identifying delays, reorganizing workflow and assigning team members specific roles.