When someone experiences a stroke, every minute matters.
In fact, nearly two million brain cells can be lost each minute when a blood clot forms in an artery in the brain, disrupts blood flow, and is not treated. That’s why one of the most important measures of stroke care quality is how quickly a patient receives clot-busting medication from the time they arrive at the hospital, known as Door-to-Needle (DTN) time.
Adventist HealthCare White Oak Medical Center’s (WOMC) achievement of the American Heart Association’s Get With the Guidelines® – Stroke Gold Plus Award with Target: Stroke Honor Roll reflects a sustained commitment to not only meeting, but exceeding national standards for rapid stroke treatment, ensuring patients receive the right care at the right time.
The Challenge
National guidelines recommend that eligible stroke patients receive treatment within 60 minutes of arrival, with leading programs consistently achieving treatment in 45 minutes or less. While those benchmarks are clear, achieving them reliably is challenging.
Stroke patients often arrive with complex symptoms or uncertainty about when stroke symptoms began. At the same time, care teams must quickly coordinate emergency physicians, neurologists, nurses, radiology, pharmacy and laboratory services, often within minutes of arrival and across all hours of the day.
Even small inefficiencies can lead to treatment initiation delays. The ongoing challenge is to deliver fast, reliable care for every eligible patient, every day, while striving to meet and exceed DTN time targets.
Process Improvement
Using standard Lean Six Sigma principles, the WOMC stroke team closely examined each step of the stroke care process to identify delays, variation and opportunities for improvement. This included reviewing stroke cases, tracking performance data and listening to frontline staff.
These reviews revealed common barriers to faster DTN times such as:
- Variability in how quickly stroke alerts were activated
- Diagnostic imaging and interpretation delays
- Inconsistent medication availability
- Delays in blood pressure management prior to medication administration
- Unclear role expectations during stroke alert activations
From a high-reliability perspective, the focus was on building systems that perform well even under pressure, reducing reliance on workarounds or individual heroics.
Solution
To address these challenges, the stroke team implemented targeted improvements designed to make rapid treatment the standard, not the exception. Key changes included:
- Early stroke alert activation, allowing teams to work in parallel rather than sequentially
- Streamlined imaging pathways with clear turnaround expectations
- Improved medication readiness, ensuring clot-busting therapy was available without delay
- Clearly defined team roles in the Emergency Department (ED) and non-ED settings that coordinate multidisciplinary stroke care specialists, reducing treatment delays
These standardized workflows reflect Lean principles of eliminating waste and high reliability organization (HRO) principles of preoccupation with failure and deference to expertise, ensuring the right actions happen at the right time. This proactive, systematic approach has fostered a culture of continuous improvement, setting it apart from traditional DTN efforts.
Ongoing Outcomes: Reliable Performance That Improves Lives
As a result of these efforts, WOMC’s stroke program has consistently met national DTN benchmarks, qualifying for the American Heart Association’s Get With the Guidelines® – Target: Stroke Honor Roll, which recognizes hospitals that reliably achieve rapid treatment times for eligible patients.
For patients, faster DTN times mean:
- Quicker access to life-saving treatment
- Lower risk of long-term disability
- Better chances for recovery and independence
Achieving this award reflects sustained performance, not a single success. WOMC’s teams continue to monitor data, refine processes and reinforce best practices to ensure our community receives timely, high-quality stroke care when it matters most.
