Abstract 87: Evolution of the 24-Hour In-House Stroke Team

Abstract

Background and Issues: In 1998, Providence St. Peter Hospital (PSPH) created its first stroke team. An on-call Stroke RN/neurologist duo responded to pages from the emergency center and inpatient attending physicians and nurses 24 hours a day, 365 days a year. By late 2010, the responsibilities of the stroke team members had significantly increased, but only two Stroke RNs and one neurologist participated on the team. It became clear that the 100% on-call model had become resource limited and processes were now inconsistent. The development of a sustainable new stroke model was critical. Purpose: The purpose of the project was to create a sustainable in-house stroke patient care process that would meet the community’s need for excellent stroke care while maintaining Joint Commission Primary Stroke Center certification. Methods: In early 2011, an interdisciplinary team convened to develop the new process. Members included RNs and physicians from neuroscience, emergency center, and primary care, radiologists, CT technicians, pharmacists, and phlebotomists. Stroke clinical guidelines, best practices and outcome data were reviewed. Operational, financial and clinical opportunities for improvement were identified. Results: As a result, two separate initiatives were implemented, (a) in-house acute stroke response and (b) emergency center acute stroke response, both which are active 24 hours per day, 365 days per year. Seven neurologists now rotate call as the stroke neurologist. One of sixteen neuroscience RNs is onsite 24 hours a day as the Stroke RN. Acquisition of a telestroke robot enables the stroke neurologist to assess the patient immediately and make treatment decisions that are initiated before the neurologist arrives at the hospital. Procedures are outlined for all involved departments, ensuring timely diagnostics completion, appropriate medication administration or intervention, and consistently high standards of care. Conclusions: In conclusion, the revised stroke patient care management processes have proven to be sustainable and effective in ensuring timely intervention and positive outcomes for stroke patients. The program is reviewed and updated monthly.