Delnor Hospital develops faster stroke treatment, earning Honor Roll-Elite Plus designation

Mary Pietruziewicz was enjoying a cocktail with her husband when her speech became garbled. Concerned, he rushed her to Northwestern Medicine Delnor Hospital's Emergency Department where a CT scan revealed a blood clot in her brain. Pietruziewicz was having an ischemic stroke.

Under new protocols at Delnor Hospital, it took only 38 minutes after Pietruziewicz arrived to receive a thrombolytic medication via IV to dissolve the blood clot. The American Heart Association recommends a door-to-needle time of under 60 minutes. Always striving for better, the Delnor Hospital stroke team initiated a quality improvement project to become even more efficient.

"Seconds count when it comes to preserving brain function. Every minute that a stroke goes untreated, 1.9 million neurons are lost," said Dhruvil J. Pandya, MD, medical director of the stroke program at Northwestern Medicine Delnor Hospital.

Since launching the project last year, the average time taken to administer the thrombolytic medication has decreased from 63.5 minutes to 32.5 minutes. Cutting the time nearly in half, these 31 minutes equate to 58.9 million neurons saved.

The American Heart Association's Get with the Guidelines-Stroke program recently recognized the achievement by advancing Delnor Hospital up from Honor Roll-Elite status in 2022 to Honor Roll-Elite Plus status in 2023.

For Pietruziewicz, the rapid treatment meant a better functional outcome and much faster recovery. After a short hospitalization and a few weeks of inpatient rehabilitation at Northwestern Medicine Marianjoy Rehabilitation Hospital, the 86-year-old says she felt like herself again.

"I may not have the same get-up-and-go, but I'm very active gardening, cooking and I actually enjoy dusting the house," said Pietruziewicz. "Everyone at Delnor and Marianjoy took really good care of me."

Pietruziewicz is doing so well, the avid doll collector recently traveled to Indianapolis for the Madame Alexander Doll Convention, and she is looking forward to attending another convention in South Carolina soon.

"The team has tirelessly dedicated themselves to saving the lives of patients experiencing a stroke and ensuring they receive life-changing treatments as expeditiously as possible," said Dr. Pandya. "As a result, we have observed remarkable advancements in our promptness in providing thrombolysis treatment, leading to better outcomes for our community."

Many steps are required before a thrombolytic can be administered, including a thorough exam by a neurologist and a CT scan to confirm the stroke is due to a blockage (ischemic stroke). Thrombolytics cannot be given to patients with a brain bleed (hemorrhagic stroke) as it would cause additional bleeding.

This complex process requires collaboration between the emergency medicine physicians, nurses, CT technologists, radiologists, neurologists, pharmacists, pharmacy technicians and more. They must be in constant communication and move quickly and accurately.

Delnor Hospital's stroke team worked with Northwestern Medicine's Performance Improvement Office to map out the process and come up with creative solutions to optimize the process.

For example:

• Not all Emergency Medical Services (EMS) stretchers are labeled with their weights, so patients arriving via ambulance could not be weighed until after their CT scan, delaying the pharmacy's preparation of the thrombolytic medication. The new process includes moving patients from EMS stretchers into Northwestern Medicine beds at registration so they can be weighed upon arrival.

• A wheelchair scale was installed, and wheelchairs in the department were labeled with their weights, so that patients using wheelchairs could be weighed upon arrival.

• The team implemented Vocera, a mobile phone-based system, to streamline the communication process and keep everyone informed.

• The triage team received education to help them know when to call a stroke alert. They also were empowered by learning they cannot "overcall" and that it is OK if they call a stroke alert for someone who ends up having not experienced a stroke.

• All supplies needed for the process are readily available on the floor, called a thrombolytic "tacklebox."

"It has been absolutely amazing to see how our team has come together to improve this very important service for our community," said Ankur A. Dhawan, DO, assistant director of emergency medicine at Northwestern Medicine Delnor Hospital. "The mind shift of considering thrombolytics as a possibility, to committing to it as a standard of care, has been incredible. I feel so proud that we can provide this level of care for our patients and their families."

According to the American Heart Association, studies have found that less than 30%of U.S. patients with acute ischemic stroke are treated within the 60-minute door-to-needle window.

To earn Stroke Honor Roll-Elite Plus designation, hospitals must achieve door-to-needle times within 45 minutes for at least 75% of applicable patients and door-to-needle times within 30 minutes for at least 50% of applicable patients.

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