Introduction Mechanical Thrombectomy (MT) is now the gold standard for acute large vessel occlusion ischemic stroke. Actualizing MT for eligible patients is a time-sensitive, multi-disciplinary, multi-step endeavor. As ‘time is brain’, we embarked on a multi-disciplinary quality improvement project to reduce door-to-puncture time (DPT) for MT.

Aim of Study Identify and improve processes along the patient journey from door to puncture to reduce DPT for MT eligible patients from a median of 130 minutes to 80 minutes, in line with American Stroke Association targets.

Methods The project was conducted in 2 broad phases: current state analysis, followed by solution development and implementation. Various parts of MT were identified. Existing literature was studied, and innovative ideas were generated for applicable solutions on each part. These solutions were put through Plan, Do, Study, Act (PDSA) iterative cycles. Solutions were piloted across 4 PDSA cycles. Multiple interventions were applied along the PDSA cycles, including concepts of parallel processing, standardization and training, active feedback to nudge behavior, push systems, technological tools, and elimination of steps.

Results A total of 88 cases between June 2021 and January 2023 were included in analysis. Following the 4th PDSA cycle, median DPT reduced by 36.5% from 130 mins to 82.5 mins.

Conclusion MT is a complex process. Analysis of the process from multiple angles and intervening on multiple small aspects can add up to significant improvement in DPT.

Disclosure of Interest no.