Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers

Background Patients with acute stroke at non‐ or primary stroke centers (PSCs) are transferred to comprehensive stroke centers for advanced treatments that reduce disability but experience significant delays in treatment and increased adjusted mortality. This study reports the results of a proactive...

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Autores principales:	Jane L. Holl, Rebeca Khorzad, Rebecca Zobel, Amy Barnard, Maureen Hillman, Alejandro Vargas, Christopher Richards, Scott Mendelson, Shyam Prabhakaran
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	acute stroke door‐in‐door‐out failure modes, effects, and criticality analysis Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/7bab13ead41c40beaa0dbf9506dcdd42
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spelling	oai:doaj.org-article:7bab13ead41c40beaa0dbf9506dcdd422021-11-23T11:36:35ZRisk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers10.1161/JAHA.121.0218032047-9980https://doaj.org/article/7bab13ead41c40beaa0dbf9506dcdd422021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021803https://doaj.org/toc/2047-9980Background Patients with acute stroke at non‐ or primary stroke centers (PSCs) are transferred to comprehensive stroke centers for advanced treatments that reduce disability but experience significant delays in treatment and increased adjusted mortality. This study reports the results of a proactive, systematic, risk assessment of the door‐in‐door‐out process and its application to solution design. Methods and Results A learning collaborative (clinicians, patients, and caregivers) at 2 PSCs and 3 comprehensive stroke centers in Chicago, Illinois participated in a failure modes, effects, and criticality analysis to identify steps in the process; failures of each step, underlying causes; and to characterize each failure’s frequency, impact, and safeguards using standardized scores to calculate risk priority and criticality numbers for ranking. Targets for solution design were selected among the highest‐ranked failures. The failure modes, effects, and criticality analysis process map and risk table were completed during in‐person and virtual sessions. Failure to detect severe stroke/large‐vessel occlusion on arrival at the PSC is the highest‐ranked failure and can lead to a 45‐minute door‐in‐door‐out delay caused by failure to obtain a head computed tomography and computed tomography angiogram together. Lower risk failures include communication problems and delays within the PSC team and across the PSC comprehensive stroke center and paramedic teams. Seven solution prototypes were iteratively designed and address 4 of the 10 highest‐ranked failures. Conclusions The failure modes, effects, and criticality analysis identified and characterized previously unrecognized failures of the door‐in‐door‐out process. Use of a risk‐informed approach for solution design is novel for stroke and should mitigate or eliminate the failures.Jane L. HollRebeca KhorzadRebecca ZobelAmy BarnardMaureen HillmanAlejandro VargasChristopher RichardsScott MendelsonShyam PrabhakaranWileyarticleacute strokedoor‐in‐door‐outfailure modes, effects, and criticality analysisDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute stroke door‐in‐door‐out failure modes, effects, and criticality analysis Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	acute stroke door‐in‐door‐out failure modes, effects, and criticality analysis Diseases of the circulatory (Cardiovascular) system RC666-701 Jane L. Holl Rebeca Khorzad Rebecca Zobel Amy Barnard Maureen Hillman Alejandro Vargas Christopher Richards Scott Mendelson Shyam Prabhakaran Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers
description	Background Patients with acute stroke at non‐ or primary stroke centers (PSCs) are transferred to comprehensive stroke centers for advanced treatments that reduce disability but experience significant delays in treatment and increased adjusted mortality. This study reports the results of a proactive, systematic, risk assessment of the door‐in‐door‐out process and its application to solution design. Methods and Results A learning collaborative (clinicians, patients, and caregivers) at 2 PSCs and 3 comprehensive stroke centers in Chicago, Illinois participated in a failure modes, effects, and criticality analysis to identify steps in the process; failures of each step, underlying causes; and to characterize each failure’s frequency, impact, and safeguards using standardized scores to calculate risk priority and criticality numbers for ranking. Targets for solution design were selected among the highest‐ranked failures. The failure modes, effects, and criticality analysis process map and risk table were completed during in‐person and virtual sessions. Failure to detect severe stroke/large‐vessel occlusion on arrival at the PSC is the highest‐ranked failure and can lead to a 45‐minute door‐in‐door‐out delay caused by failure to obtain a head computed tomography and computed tomography angiogram together. Lower risk failures include communication problems and delays within the PSC team and across the PSC comprehensive stroke center and paramedic teams. Seven solution prototypes were iteratively designed and address 4 of the 10 highest‐ranked failures. Conclusions The failure modes, effects, and criticality analysis identified and characterized previously unrecognized failures of the door‐in‐door‐out process. Use of a risk‐informed approach for solution design is novel for stroke and should mitigate or eliminate the failures.
format	article
author	Jane L. Holl Rebeca Khorzad Rebecca Zobel Amy Barnard Maureen Hillman Alejandro Vargas Christopher Richards Scott Mendelson Shyam Prabhakaran
author_facet	Jane L. Holl Rebeca Khorzad Rebecca Zobel Amy Barnard Maureen Hillman Alejandro Vargas Christopher Richards Scott Mendelson Shyam Prabhakaran
author_sort	Jane L. Holl
title	Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers
title_short	Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers
title_full	Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers
title_fullStr	Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers
title_full_unstemmed	Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers
title_sort	risk assessment of the door‐in‐door‐out process at primary stroke centers for patients with acute stroke requiring transfer to comprehensive stroke centers
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/7bab13ead41c40beaa0dbf9506dcdd42
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Risk Assessment of the Door‐In‐Door‐Out Process at Primary Stroke Centers for Patients With Acute Stroke Requiring Transfer to Comprehensive Stroke Centers

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