Abstract 2734: Thrombolytics, Treatment, Transfer, and Triage: Improving Access to Stroke Care in Eastern North Carolina
Background: We are a Certified Primary Stroke Center (PSC) at a regional health system serving 29 counties in eastern North Carolina. High poverty rates, socioeconomic, and demographics factors, create challenges for access to care in the heart of the stroke buckle. Purpose: This endeavor promotes best practice for acute stroke care and optimizes outcomes for patients. The PSC serves as the hub, offering supportive resources to community hospitals with an immediate feedback loop that fosters a seamless transfer process through a drip and ship model. As a result of outreach efforts in the region, an increased number of patients will receive thrombolytic therapy. Implementation of this model creates a community network that is well prepared to become a true stroke system of care.
Development of a comprehensive transfer protocol that includes an algorithmic decision tree and continuous quality feedback loop
Ongoing data analysis and sharing
Key stakeholder collaboration
24/7 resource availability
Immediate feedback loop to include phone calls
Results: Regional transfers to our facility after t-PA, increased steadily each year from six in 2006 to 52 in 2010, illustrating a significant increase in t-PA utilization. Clinical outcomes were tracked throughout the hospital course to identify stroke severity and disposition. This resulted in a comprehensive analysis of all regional transfers post t-PA, prompting evaluation of t-PA utilization based on phone consults and the feasibility of triage for admission to an ICU or IU based on 18 months of clinical data.
Last NIHSS < 12, favorable outcomes
71% of regional transfers had a last NIHSS < 12, 61% were discharged home, 34% Rehab, 5% SNF
Regional and PSC average NIHSS comparison: Regional first NIHSS was13, last NIHSS - 9.9; PSC first NIHSS -11.5, last NIHSS 5.2
Conclusions: An increased number of patients are receiving thrombolytic therapy in our community hospitals as a result of outreach efforts in the region. Regional partnerships continue to grow. With growth comes an increased responsibility to explore every aspect of acute stroke treatment that may impact overall clinical outcomes. While the clinical efficacy of t-PA for stroke has been proven in numerous clinical trials, we are obligated as a PSC to take stroke care to the next level and continuously evaluate opportunities for improvement that will guide us to maximize EVERY patient’s outcome.
- © 2012 by American Heart Association, Inc.