Abstract Details

Title Improving Outcomes for In-Hospital Stroke: A Single Center Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P15 - Poster Session 15 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-002

Objective Provide the opportunity to treat more in-hospital stroke patients due to faster recognition and rapid stroke evaluation.

Background Saving brain cells is a concept that permeates the Emergency Department setting, and the processes to reduce door-to-intervention times in the ED have revolutionized stroke care. However, stroke innovations instituted in our ED setting were not crossing over to the in-patient setting leading to permanent preventable serious safety events.

Design/Methods Stroke and in-hospital safety teams collaborated to remove barriers and accelerate diagnosis of in-patient stroke. Two crucial components present in the emergency department, but not within the hospital setting were identified: standardizing in-hospital stroke order sets to mirror ED order sets and increasing stroke recognition for bedside nurses as well as for responding staff. Key processes were changed to mirror emergency department stroke evaluation including a brief history, time the patient was “last known well” and obtaining a STAT Stroke Head CT. The low cost, targeted changes provided faster recognition and increased opportunities for brain-preserving treatment and intervention.

Results In the hospital, six months prior to change, 22 neuro status change Rapid Responses were activated. In the six months following the interventions, 44 neuro status change alerts were initiated, resulting in a 100% increase. In the same period, the time between the Rapid Response assessment and CT interpretation averaged 66 minutes, but dropped to 37.8 minutes after intervention, a 43% change in improved efficiency. Most importantly, nine patients underwent thrombectomy and two patients received alteplase, compared to zero the year prior.

Conclusions Time criticality for stroke is imperative. Hospitals must not only teach the community but also engage and train employees within their own walls to rapidly recognize treatable strokes. Further study is planned reduce in-hospital treatment times and create a more standardized model across all sizes of hospitals and in-patient care settings.

Authors/Disclosures
Angela M. Hawkins, RN (Saint Lukes Health System) PRESENTER	No disclosure on file
Harold H. Morris III, MD, F�鶹��ýӳ�� (Saint Lukes Neurological Consultants)	No disclosure on file

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