An acute ischemic stroke intervention turned a simple text system into significant improvements in door-to-needle times for one center, according to a study published online Oct. 28 in Stroke.

The stroke team at the University of California, San Francisco, developed a text-message system to keep the whole group updated as acute ischemic stroke patients entered and progressed through treatment. Neurologist Molly M Burnett, MD, and colleagues created the system to combat erosion in best practices and accountability due to frequent turnover of residents and fellows.

Following a teamwide text announcing the arrival of an ischemic stroke patient, texts were sent in real time to the entire Code Stroke team by the team leader to report administration of intravenous tissue-type plasminogen activator and door-to-needle times. As part of quality improvement efforts, any cases where door-to-needle time was longer than 60 minutes were reviewed within 24 to 72 hours to identify and address barriers to timely treatment. Biweekly, the group shared performance updates.

Code Stroke texts began in April of 2011; the team analyzed data from 2008 through 2014 to encompass approximately three years before and three years after to see if the intervention had been successful. Analysis included 94 patients from the preintervention period and 108 patients in the postintervention period.

Through the text system and continuous improvement method, median door-to-needle times were reduced from 82 minutes preintervention to 56 minutes. More patients were treated within 60 minutes with the intervention: 63 percent of patients as opposed to 16 percent in the preintervention period.

The team noted no significant differences between pre- and postintervention for incidence of in-hospital death (13 percent vs. 6 percent, respectively), stroke mimics (10 percent vs. 8 percent, respectively), or intracranial hemorrhage (4 percent for both pre and post).

Burnett et al wrote that the intervention was meant to focus team goals and provide timely feedback in a way that didn’t reduce efficiency. They noted that, “a real-time reporting mechanism allows for a tighter feedback loop while the clinical details of a particular case are still fresh in the minds of team members.”

“It may also serve to increase accountability for DTN [door-to-needle] performance – an especially relevant issue at centers where staff turnover can contribute to a diffusion of accountability.” They did note that infrastructure and protocol changes could be implemented to further refine the process, however.

The intervention, they wrote, could be easily adopted and adapted elsewhere with the potential to be equally successful in other settings.