Abstract 83: Early Notification Using a Novel Three-Tiered Code Stroke System Reduces Neurointerventional Team Activation Times

Abstract

Background: Although Code Stroke group page systems are essential to accelerate endovascular therapy (EVT), their design and implementation has not been well-studied. We assessed a novel 3-tiered system crafted to facilitate prompt, stepped activation. Methods: An escalating 3-tiered system was designed to provide salient services with both an a) alert-be ready page, and a b) go-go-go page while minimizing false alarms. Group page levels are: 1) pre-arrival notification of possible stroke by EMS to Neurology; 2) notification of possible large vessel occlusion (LVO) by Neurology (based on cortical signs) to Neurointerventional+/Anesthesia; and 3) post-imaging notification of confirmed LVO and angiosuite decision to all services. System performance was assessed over a 1 year period September 2022 to August 2023. Results: Among 798 Code Strokes, 75 (9.4%) patients received EVT, including 45 who were EMS-arriving. Among the 45 LVO strokes treated with EVT, 26 (58%) had an early notification (EN) Level 2 page pre-imaging and 19 (42%) only a late notification (LN) Level 2 page post-imaging. Patients in the EN vs LN group were nominally older (84 vs 74), more often female (61.5% vs 47.3%), and more severely affected (NIHSS 16 vs 13). Time metrics are presented in Table 1 and Figure 1. The EN group had a near 40 minute decrease in door-to-puncture (DTP) and 50 minute decrease in door-to-reperfusion (DTR) times. Conclusion: All levels of a 3-tier (pre-arrival, pre-imaging, and post-imaging) Code Stroke group page system were activated frequently in EVT patients and pre-imaging early notification of neurointerventional and anesthesia teams was associated with markedly reduced DTP and DTR times.