Abstract 114: 24/7 Stroke Nurse Team Coverage Reduced Door-to-needle Time and Improved Tissue Plasminogen Activator Utilization Rates in a Stroke Level 1 Community Hospital
Background: Although the American Heart Association has placed particular emphasis on the importance of improving door-to-imaging (DTI) and door-to-needle (DTN) times, treatment with intravenous tissue Plasminogen Activator (IV tPA) remains nationally low in Acute Ischemic Stroke (AIS) patients, especially for community hospitals due to a lack of in-house neurovascular physician coverage. We sought to remedy this problem by implementing round-the-clock coverage of the Emergency Department by Stroke-trained nurses for patients presenting with AIS who may be appropriate to receive IV tPA.
Methods: AIS patients treated with IV tPA at a Community Hospital and Primary Stroke Center in St. Louis, Missouri were studied between 2013 and 2016. A 24/7 Rapid Response Team of nurses was trained as specialized stroke responders for which the DTI time, DTN time, and IV tPA utilization rates were then compared between pre-implementation (12 months) and post-implementation (30 months).
Results: We studied 189 Stroke Code patients who were treated with IV tPA (40 pre-implementation and 149 post). The median DTI time was reduced from 16 minutes (interquartile range [IQR]10-21) to 11 minutes (IQR 6-12) (P < .05), and the median DTN time was reduced from 64 minutes (IQR 44-79) to 51 minutes (IQR 39-65) (P<.05). Compliance within the 60-minute benchmark DTN time improved from 55% (27 of 44 patients) to 76.1% (113 of 149 patients) treated in less than 60 minutes with 53.5% (80 of 149 patients) being treated in less than 45 minutes (P<.05). The tPA treatment rates also increased pre and post-implementation by 77.5% (40 to 71 patients) (P<.05) while IV tPA complication rates decreased from 7.3% to 2.7% (P<.10).
Conclusions: Implementation of round-the-clock on-site stroke nurse coverage for Acute Stroke Code significantly reduced the DTI and DTN time while increasing treatment rates and decreasing complications amongst patients with AIS treated with IV tPA.
Author Disclosures: Z. Haque: None. M. Enchelmeier: None. S. Bern: None. M. Malik: None.
- © 2017 by American Heart Association, Inc.