Abstract 9

When it comes to acute ischemic stroke (AIS), we know that “time is brain.” Getting a patient from the ambulance to the CT scanner and ultimately delivering tPA to bust up a clot requires the timely organization and execution of many complex, parallel steps. The rapidity of the progression through these steps, however, may not be solely reliant on the recognition of the disease and delivery of medications, but also the busyness of the ED or the experience of individual providers or as a team.

In our exploratory work, we sought to better understand the contextual factors that affect the ability to deliver definitive care. We utilized the audit log - a record of all EHR interactions - to identify contextual factors that might affect the door to needle time for AIS patients. An expert panel of emergency providers, stroke neurologists, and informaticians convened to determine a list of computable contextual factors which were then extracted from three separate healthcare institution’s EHRs. Social network analyses were used to determine team interactions across patient encounters.

We were able to identify and measure the effect of features like busyness (at the departmental, team, and provider levels) as well as experience (at the team and individual levels) on the door to needle time (DNT) for AIS patients. While most of these contextual factors had a small impact on the ultimate DNT, the most powerful relationship existed for team experience. The more team members worked together on other cases, the faster tPA tended to be delivered. Perhaps "team" is brain?!