Abstract NS8: Improving Acute Ischemic Stroke Improving Acute Ischemic Stroke Treatment Rates: Improving Acute Ischemic Stroke Treatment Rates: Can a Non-Traditional Stroke Response Team Measure Up?
Background: Emergent response to stroke requires internal hospital resources and manpower to ensure delivery of rapid protocolized care. We compared the safety, effectiveness, and efficiency of an innovative Acute Stroke Response Team (I-ASRT) consisting of nurse practitioners, physician assistants, and critical care physicians, compared to a traditional neurologist (T)-ASRT model.
Methods: A retrospective descriptive study was conducted to examine the effect of an I-ASRT on IV-tPA treatment rates, safety, and door-to-needle (DTN) times, compared to a T-ASRT at a tertiary Stroke Center in the Midwestern U.S. Stroke registry data from April 2007 to October 2013 were analyzed. Stroke mimic syndromes, hemorrhagic stroke, or drip and ship transfers were excluded. Safety was defined by rate of IV-tPA associated sICH defined as ≥ 4 point change of NIHSS in combination with PH-2 hemorrhage on CT.
Results: 1278 ASRT patients were included; 340 (27%) of cases were managed by the T-ASRT and 938 were managed by the I-ASRT. Overall, the sample was 84% White non-Hispanic, 5% White Hispanic, 9% African American, 0.5% Asian, 0.5% Native American, 0.5% mixed race, and 0.5% unknown. Overall median admission NIHSS was 4. Stroke patients were most commonly female, and those managed by the T-ASRT had significantly worse neurologic disability on NIHSS (9.6+/-7.4 vs. 5.8+/-7.1, <.0001), and longer LOS (4.6+/-3.3 vs. 3.7+/-4.9 days, <.0001) compared to those managed by I-ASRT. IV-tPA rates were similar between groups (T-ASRT=16%; I-ASRT=15%; p=ns). Door-to-needle times were statistically similar, although a clinically important 31 minute reduction was achieved by the I-ASRT (I-ASRT=52 +/- 23 minutes vs. T-ASRT=83 +/- 21 minutes; p=ns). T-ASRT sICH rate was 10% vs. a clinically important, but non-significant sICH rate of 5% in I-ASRT patients.
Conclusions: Our findings are consistent with other studies demonstrating safe expansion of nurse practitioner and physician assistant roles to include IV-tPA decision making following completion of neurovascular fellowship training.
Author Disclosures: W. Dusenbury: None. A. Alexandrov: Speakers' Bureau; Modest; Genentech. S. Taylor: None.
- © 2015 by American Heart Association, Inc.