Abstract NS12: Inpatient Stroke Code, an Accurate Activation
Background: In 2011, it was noted by the hospital that multiple stroke code activations were occurring on inpatients that did not have signs of focal neurological deficit, or stroke. In a six-month retrospective review, a total of 32 inpatient stroke codes were identified. Of these, only 8.6% of patients had a focal neurologic deficit. The remainder had other symptoms, such as alteration in level of consciousness. In addition to the potential harmful effects of unnecessary testing, cost was also considered. A code stroke protocol testing and staffing accumulates approximately $358.00 in cost during the first hour. This is in comparison to the rapid response team activation, which incurs $79.00 during the first hour.
Purpose: For inpatient stroke codes, does a floor RN activated RRT, directly followed by an ICU RN activated stroke code, if applicable, reduce the number of inappropriate inpatient stroke code activations?
Methods: Following literature review, it was decided by the Stroke Code Team to move having an initial RRT activation by the floor RN who suspects her patient may be having an acute stroke. Then, as part of the RRT, an ICU RN would arrive at the bedside and evaluate the patient. Following assessment, and if it was felt appropriate, a stroke code would be initiated.
Results: A 30-day period was closely examined for potential impact. During this period, 11 Stroke Codes were identified. Of these, 3 stroke codes were activated without the RRT and did not follow the new protocol. Of the remaining 8 RRT activations, 6 lead to stroke codes. Of these, 2 of 6 (33.3%) had an accurate diagnosis of acute onset stroke. This indicates a 25% decrease in the number of inaccurate stroke code.
Conclusion: Since the RRT activation was an additional step, a primary concern with the change in protocol was the delay in treatment of IV tPA. It did not result in a delay in care, and the time from RRT activation to stroke code team arrival was less than 4 minutes. If the initial RRT activation in place of stroke code was to continue at this pace, an approximate annualized savings of at least $10,800.00 could be achieved. Further data analysis and study is warranted in order to determine long-term cost avoidance and implications to the change in protocol.
- © 2012 by American Heart Association, Inc.