Abstract TP193: Achieving Target Stroke Advanced Therapy Without Advanced Communications Technology Through Cost-Neutral Optimization: Applying Lippitt’s Change Theory at a Thrombectomy Stroke Certified (TSC) and Comprehensive Stroke Certified (CSC) Center

Abstract

Background: In 2019 the AHA/ASA updated stroke treatment benchmarks in Target Stroke Phase III, including a goal Door to Device (DTD) ≤90 minutes for direct arriving large vessel occlusion (LVO) strokes eligible for thrombectomy. Without access to costly advanced communications technology applications or additional funding, a high-volume TSC and CSC were challenged to meet this DTD goal and achieve Target Stroke Advanced Therapy Awards, improving treatment times and patient outcomes. Objective: Implement Lippitt’s Change Theory to standardize workflows in the emergency department (ED) and cardiovascular lab (CVL) and optimize collaboration between Stroke Neurology and Neurointerventional Radiology (NIR) providers to reduce DTD times for direct arriving LVO cases. Methods: Stroke registry baseline data from 2020-2023 showed median direct-arriving DTD times of 112 minutes (n=132) at the CSC with 13.6% achieving DTD ≤90 minutes, and median of 117 minutes (n=146) at the TSC with 21.9% achieving DTD ≤90 minutes. Interventional Radiology RNs at the two sites acted as Change Agents, examining existing stroke workflows to identify sequential processes that could be managed in parallel, without using additional technology applications to streamline imaging or activation process workflows. The CVL teams at both sites were considered multi-specialized, with stroke and neurosurgery making up a relatively small percentage of overall cases. We incorporated the seven steps of Lippitt’s Change Theory emphasizing the participation of staff affected by the proposed changes. Key changes included earlier NIR consultation, earlier CVL activation, standardized room preparation, standardized processes for each CVL role, early NIR presence in CVL, identification and elimination of redundant tasks, development of new data visualization dashboards, and establishment of new time goals for all process components. Results: Applying Lippitt’s Change Theory enabled the creation of standard processes and workflows for a multi-specialized CVL team at both a TSC and CSC that significantly reduced DTD times. Conclusion: Successful implementation and sustainability of new processes applying Lippitt’s Change Theory was achieved: both the TSC and the CSC received Target Stroke Advanced Therapy Awards in 2024 and 2025. Target Stroke Phase III tools are feasible to employ at fiscally constrained programs and sufficient to achieve DTD time goals in the absence of advanced communication applications.

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