Abstract 43: Rehabilitation Evaluation at 12 Hours Post-tPA

Abstract

The current national standard of care after IV Alteplase (tPA) for stroke is bedrest for 24 hours. Because of this, rehabilitation assessments are delayed, which causes downstream delays in the patient getting to the next level of care. We sought to evaluate the feasibility, safety, and effect on length of stay in the acute stroke population post tPA. After reviewing the literature, we were able to find one small study that supported very early mobilization. We then gathered historical data and prospectively collected data on our study group. All patients who received tPA were eligible unless otherwise stated by the physician. The data was then used to determine harm, length of stay, and time to rehabilitation assessment. During the study time period, 87 patients were seen after 12 hours at a median of 17 hours post tPA. An additional 60 patients were seen after 24 hours due to being sedated, or staffing. In the pre-study phase there were no falls noted for patients who remained in bed for 24 hours. The study group similarly had no falls. There were also no incidents of worsening, 1 incidence of hypotension, in the study population. The length of stay in the study group was reduced from 4.5 days to 1.9 days. We now are able to safely monitor these patients and use evidence to drive decisions in care. This small study further supports the idea of early mobilization and treatment as safe, effective, and feasible. Stroke patients are safely able to receive more timely care which helps drive them towards further rehabilitation. This change in culture has resulted in greater patient satisfaction, improved flow through the levels of care, and a more evidence based practice.