Abstract TP332: Utilizing a Neuro Intermediate Unit in Caring for Post-Thrombolysis Stroke Patients
Background: Historically stroke patients receiving intravenous tPA are admitted to an intensive care unit (ICU). Providing post-tPA care in a non-ICU setting could result in cost reduction and allow allocation of ICU beds to other critically ill patients. We sought to determine if care can be provided safely and effectively for post-tPA patients in a Neuro Intermediate Unit (NIU).
Materials and Methods: This is a retrospective case series study performed in a tertiary academic medical center with a comprehensive, accredited, stroke program. We analyzed ischemic stroke patients admitted to our NIU during a 24-month period. A standardized data collection form was used to abstract data from medical records.
Results: During a 24-month period 104 patients were admitted for post-tPA stroke care. The sample is composed of 60 males and 44 females. The median age was 69.5 and the mean age was 67.96. The sample is composed of 72 (69%) White and 32 (31%) Black patients. The mean admission NIHSS was 9.32. The most common stroke risk factors were hypertension (76%), diabetes mellitus (25%), hyperlipidemia (51%), tobacco use (21%), atrial fibrillation (21%), prior stroke (26%), congestive heart failure (20%), and coronary artery disease (21%). Mean admission systolic blood pressure was 143.5 mm Hg. For blood pressure management, 18% of the patients received medication by intravenous push and 5.7% by continuous infusion to meet established goals. Gastrointestinal hemorrhage was seen in 1.9%, intracranial hemorrhage in 3.8%, and blood transfusions needed in 1.9%. Insulin drips were needed to control persistent hyperglycemia in 3.8%. Sepsis occurred in 0.96% patients. The rate of fatality was 3.8%. Excellent functional outcome as defined as Modified Rankin Score (mRS) less than 2 was seen in 46% of patients and minimal to no disability (mRS < 1) was seen in 35.6%.
Conclusions: In this retrospective study, stroke patients receiving intravenous tPA admitted to an NIU had similar outcomes and complications to that described in previous data. Significant cost savings can be accomplished by admitting thrombolysis patients to an NIU without compromising patient safety. Specialized nursing care available in a stroke unit is a key component in improving patient outcome.
- © 2012 by American Heart Association, Inc.