Resident-led Quality Improvement in the Establishment of a Comprehensive Stroke Center: Identifying Small Gaps with Large Impact
Jose Ortega Tola1, Sabrina Lora2, Mikaela Camacho Olalla1, Mohammad Badi Dabjan1, Wilson Cueva1
1Neurology, Larkin Community Hospital, 2CEDIMAT
Objective:
To evaluate the impact of resident-driven initiatives in identifying and addressing workflow inefficiencies during the establishment of a newly recognized Comprehensive Stroke Center (CSC).
Background:
CSC development requires coordinated workflows, standardized protocols, and effective interdisciplinary communication. While institutional leadership is essential, frontline providers, particularly neurology residents, often identify overlooked barriers that meaningfully impact care and outcomes.
Design/Methods:
Single-center quality improvement (QI) study with a pre–post design at a newly certified stroke center (June-August 2025), including revascularized patients treated with intravenous thrombolysis (IVT) or endovascular procedures. June served as the pre-intervention period (n=9), while July-August comprised the post-intervention period (n=8). Residents and the stroke team evaluated workflows via post-code debriefs, review of door-to-imaging (DIT) and door-to-needle (DTN) times, and interdisciplinary feedback. Solutions were implemented with nursing, radiology, and emergency medicine. Metrics were tracked and compared pre- and post-intervention using descriptive statistics.
Results:
Several modifiable barriers were identified, including inconsistent pre-notification from Emergency Medical Services (EMS), which delayed stroke alert activation, variability in rapid access to CT angiography (CTA), and delays in documenting NIHSS and post-tPA monitoring in the electronic medical record (EMR). Targeted interventions were implemented, including EMS education, dedicated imaging workflow, and standardized EMR templates. Data showed changes in DIT with a median of 10 and 9.5 minutes pre- and post-intervention, respectively, reflecting a 5% improvement. Additionally, there was an 11.5% improvement in DTN times (34.17 versus 30.25).
Conclusions:
Resident engagement in QI efforts plays a critical role in strengthening stroke systems of care, improving workflow without the need for additional resources. By identifying seemingly minor inefficiencies, residents drive changes that significantly improve performance metrics. Incorporating these feedback loops promotes a culture of continuous improvement, highlights the workforce’s value beyond direct patient care, and, with larger samples and longer follow-up, may translate into better patient outcomes.
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