Abstract 3201: Impact of a Stroke "Quick Look" Assessment on meeting Brain Attack Coalition Guidelines

Abstract

Background and Issues: Emergency Departments (ED) are challenged to meet Brain Attack Coalition Guidelines (BACG) for treatment of patients with acute stroke symptoms. BACG recommends that patients with acute stroke symptoms be assessed by a physician within 10 minutes of arrival to the ED, have a Computed Tomography (CT) scan within 25 minutes, receive results of the CT scan within 45 minutes, and receive intravenous TPA within 6o minutes if appropriate. Purpose: The purpose of our study was to radically change our delivery system for stroke patients and exceed BACG guidelines to improve patient outcomes for an emergency department servicing greater than 100,000 visits annually. Methods: The innovation that was vital in streamlining our process was a “Quick Look” neuro assessment by a physician for patients presenting with acute stroke symptoms. At-risk patients progress immediately to radiology, bypassing the traditional serial process of going straight to an ED room and waiting for the stroke team. Implementation of this “Quick Look” process included activation of the Neurologist and Rapid Response Team member. Results: A retrospective review of 479 charts between December 2009 and December 2010 was conducted to determine process outcomes. Implementation of a “Quick Look” assessment decreased “Door to Doctor” time from 10 minutes to 2.75 minutes (73% decrease); “Door to CT” time from 41 minutes to 18 minutes (56% decrease); door-to-administration-of-IV-TPA time from 82 minutes to 62 minutes (24% decrease); “Door to CT Results” time from 53 minutes to 27 minutes (49% decrease); and “Door to IV-TPA” time from 82 minutes to 62 minutes (24% decrease). Current 2011 year to date results through June 2011 meet the BACG door-to-needle time of less than 60 minutes. Conclusions: The implementation of the “Quick Look” process has sustained these positive outcomes throughout 2011, meeting BACG the first two quarters of 2011, and meeting the American Heart Association/American Stroke Association’s Target: Stroke Honor Roll. Although the success of this process improvement was driven by the stroke council; the amazing results are due to the efforts and collaboration of a highly functioning interdisciplinary Emergency, Rapid Response and Neurosciences team.