To shorten time to neurology consultation and improve acute stroke patient outcomes at the SAVAHCS in Tucson, Arizona. Secondary goals include improving stroke education of non-neurology providers, shortening time to alteplase or transfer to thrombectomy capable center, and standardization of the stroke response protocol.

The pre-project protocol for an acute stroke was to page a stroke code overhead and to the on-call hospitalist pager. A hospitalist or ED physician then evaluated the patient and determined the need to consult neurology. We hypothesized that this system leads to delay in acute stroke intervention and our aim was to improve the efficiency of this stroke response system.

We collected data from August 2018 – May 2019 based on retrospective chart review for acute strokes attended by neurology residents, focusing on time from door / concern for stroke to neurology consult. We implemented interventions at three different intervals. August 2018: neurology residents began responding to overhead stroke pages without awaiting formal consultation. November 2018: we simplified the call schedule and obtained VA neurology pagers for easier and more direct contact with neurology residents. May 2019: we acquired a new pager which received all VA stroke pages without necessitating a separate neurology consult.  Additionally, we provided stroke education for internal medicine residents in April 2019.

The average time to neurology consult from time of presentation decreased following the addition of each intervention from 198 min (N=4) to 69 min (N=7) to 48 min (N=1).

In acute stroke, time is brain. Stroke education, response to overhead stroke codes, a simplified call schedule, and designated pagers significantly reduced response times. This likely will result in increased utilization of alteplase and faster transfer to thrombectomy capable centers. We aim to push forward with quality improvement in order to provide the best available stroke care for our veterans.