Abstract W P298: Retrospective Review of Inpatient CODE STROKE and Evaluation of the Implementation and Outcomes
Background /Purpose: The goal of this study is to evaluate the effectiveness of an inpatient code stroke (ICS) process in achieving benchmarks. This study investigated the effects of an ICS on:
•Discovery to CT result (DCT)
•Discovery to MD evaluation (DMD)
•Documentation of last known normal (LKN) and NIH stroke scale (NIHSS)
The expected results are decreased DCT and DMD times, and increased compliance with documentation of NIHSS and LKN.
Methods: A multidisciplinary team developed the ICS by integrating the existing ED code stroke and rapid response team processes. All staff received education on recognition of stroke warning signs and activation of ICS prior to implementation. A retrospective case control analysis between subjects with pre and post protocols as the primary predictor and DCT as the primary outcome endpoint. An independent sample t-test between DCT and DMD time (in minutes) was conducted. Unadjusted odds ratios were calculated to assess associations in categorical variables.
Results: A total of 82 records (pre n=25, post n=57) of inpatients experiencing acute onset of stroke symptoms were examined revealing mean DCT times pre/post-protocol, respectively, of 53.3 (SD 27.6) and 49.7 (SD 18.1). No statistically significant improvement (p=.54) was identified. DMD evaluation time also failed to demonstrate a significant difference between pre/post-protocol times (9.3, 11.3, p=.45). Post-protocol documentation of the NIHSS revealed no significant change (p=.27); however, documentation of LKN was 14.4 times more likely (95% CI 3.98-51.83).
Conclusion: Implementation of the ICS resulted in a two-fold increase in identification of acute onset of stroke like symptoms. Compliance with documentation of LKN increased significantly which may be the result of the educational initiative and contributed to our increased volume of ICS. In conclusion, though the results of DCT and DMD are not statistically significant, they are promising. The 4 minute decrease in DCT time and narrowing SD suggest that the process has improved flow for in-house acute stroke patients.
Author Disclosures: A. Curtis: None. J. Radtke: None. T. Day: None. S. Blair: None. J. Henry: None. R.E. Heidel: None.
- © 2014 by American Heart Association, Inc.