Abstract NS3: Code Stroke Interventional Radiology: Streamlining Processes For Expedited Patient Identification And Door To Groin Puncture Time
Building on the success of Code Stroke as well as Code STEMI, we embarked on a journey to develop CODE STROKE IR for the streamlined delivery and appropriate identification of patients that may benefit from neuro-interventional therapies. Baseline data demonstrated our door to groin timeframe exceeded two and half hours as a result of undefined roles and responsibilities and the lack of a coordinated approach. We created a taskforce comprised of stroke team clinicians, analyst, neuro-interventionalists, as well as stakeholders from pharmacy, lab, ED, radiology, ICU and nursing.
Implementation strategies comprised mapping ideal workflow, identification of expected timeframes, algorithm development, staff training, mock drills and data review. Additionally we recognized a need to collaborate with our telestroke partners and transport agencies to assure clear communication and expedited transport of the patient to our organization. For appropriate patient selection, we included in our algorithm CT or MR diffusion perfusion mismatch and angiographic confirmation of occlusion.
Since the implementation of CODE STROKE IR in June 2011, we have been able to execute a well-choreographed streamlined approached to appropriately identify neuro-interventional rescue patients. Over 13 months we had 33 CODE STROKE IRs, of which 18 were identified as rescue candidates and proceeded to intervention. Our median door to groin time is now 89 minutes and we have a best practice of 63 minutes. Strategies to improve our processes are ongoing and consist of prompt review of each case followed by concurrent feedback to involved staff, reeducation of roles, and modification of workflow as indicated.
- © 2012 by American Heart Association, Inc.