Context: When a stroke patient comes into an emergency department, time is everything – particularly for acute ischemic strokes, which are eligible for a life-saving procedure called EVT (endovascular thrombectomy) only within a narrow window. Dr. Sandeep Kumar, a stroke neurologist at Beth Israel Deaconess Medical Center in Boston, observed that EVT case management was taking longer than it should at BIDMC and at the partner hospitals that transfer EVT cases to them. Checklists are a standard tool in clinical settings for exactly this kind of protocol adherence, and the American Heart Association had published a general stroke checklist in 2019. But Dr. Kumar saw an opportunity to design something better: a checklist built specifically around the realities of EVT stroke management, where every ED operates differently.

Year: 2021-2022

What I Did: I served as design lead through Ariadne Labs, working with two partner hospitals in the Boston area: Mount Auburn and Lawrence General. The project was mostly remote due to COVID-19, with one in-person site visit when it was safe to do so. I led the research and design process with each hospital’s stroke team – which included ED physicians, neurologists, nurses, imaging technicians, and administrators – by mapping out their stroke management workflow step by step, understanding the physical and mental spaces each step occupied, identifying where things fell through the cracks, and designing a new checklist tailored to each ED’s specific reality. Both checklists – each deceptively simple, but very thoughtfully designed – were field-tested by the full ED staff before the formal pilot launched in October 2022.

What We Made: We produced detailed workflow process maps for each hospital ED – which turned out to be useful for their own quality improvement work, well beyond the scope of this project – along with customized EVT stroke checklists and supporting materials each team requested, including a tPA administration checklist for nurses and techs. Field testing at both hospitals was a success: staff used the checklist as both a memory aid and a cognitive offloading tool, and teams adopted it for taking notes and coordinating during live cases.

A two-year pilot study concluded in 2024. The remarkable results: a 10.9-minute decrease in door-to-CT-scan times, a 13.9-minute decrease in door-to-needle times, and an estimated 89 stroke-related deaths prevented per 1,000 cases. The full study was published in The American Journal of Medical Quality, and a results deck is available here.