Abstract NS1: Nurse-Led Acute Stroke Team

Abstract

Background /Purpose: Acute stroke treatment is reliant on a consistent team approach focused on evidence-based guidelines and time-sensitive treatments. Early efficient care is crucial in maximizing favorable patient outcomes; however door-to-tPA times at our institution were not consistently less than 60 minutes. As a result, a multidisciplinary team engaged in a rapid improvement event to review barriers and identify opportunities for quality improvement. One strategy was the establishment of a 24x7 nurse-led Acute Stroke Team (AST). The budget neutral AST role was implemented to oversee and assist in delivery of time-sensitive assessment and treatment of acute stroke patients. Methods: Nurses from the neurology/stroke unit were selected for AST based on clinical expertise in assessment, communication and leadership skills. Didactic education and clinical mentoring was provided by the Stroke Advanced Practice Nurse (APN). AST nurses were relieved by the unit charge nurse when they attended stroke alerts in the emergency department or in-hospital. A log sheet was utilized to record: date and time of stroke alert calls, amount of time off the unit, and issues/concerns. A Likert-scale survey distributed to multidisciplinary hospital departments post implementation assessed satisfaction with the AST role. Results: During the first year of AST: 1) AST attended 448 stroke alerts, 2) calls averaged about 40 minutes, 3) IV tPA administration increased from 17 to 32 times (increase of 88%), 4) door-to-tPA delivered within 60 minutes increased from 3 times to 13 times (333% increase), 5) door-to-tPA time decreased from average 100 minutes to 77 minutes (23% decrease). Multidisciplinary hospital departments strongly agreed that the AST nurse assessment was valuable during a stroke alert (78%), and that the AST nurse was considered an asset to the stroke program (91%). Conclusions: Addition of the AST nurse role to the hospital acute stroke response has increased tPA usage, improved door-to-tPA times, and enhanced department collaboration. AST nurses continue to expand their clinical knowledge and expertise regarding the continuum of stroke care, gain leadership skills, and appreciate their role in positive patient outcomes.