Abstract P117: Stroke-Nurse Triage: Effects on Time Metrics at a Regional Stroke Center

Abstract

Introduction: Optimization of time metrics in the management of acute stroke is a priority. Nurses with special training in stroke management may contribute to enhanced delivery of care. This study analyzes the effects of initiating a nurse-led stroke triage program at a regional stroke center on time metrics of acute stroke. Methods: Registered nurses (RNs) who received specialized stroke training including NIHSS certification were designated to each presenting stroke code at our institution. The stroke RN was responsible for initial assessment, obtaining NIHSS, continued monitoring of the patient, and maintaining timely progression of care. Metrics including time from arrival to assessment by emergency department (ED) physician, assessment by a neurologist, head CT scan, the start of tissue plasminogen activator (tPA) administration, and puncture for mechanical thrombectomy were recorded. In retrospective review, stroke metrics 25 months prior to the start of the triage program (controls) and 23 months after the start of the program (cases) were analyzed. Results: 1,019 patients presented with symptoms of acute stroke during the study duration, with 293 presenting pre-program initiation and 796 presenting post-program initiation. No significant differences during this period were seen for primary outcomes of time from arrival to assessment by ED physician, CT scan, start of tPA administration, or groin puncture. A significant increase in time to assessment by a neurologist was observed (pre-program: 12.24 minutes, post-program: 17.42 minutes, p<0.001). There was no difference before or after the program in Modified Rankin Scale (mRS) scores at discharge. Conclusions: Implementation of the stroke-nurse triage program involved the delegation of tasks previously under the responsibility of ED physicians to the stroke nurses. This delegation did not negatively impact care as determined by the lack of significant difference pre- and post-program for the primary metrics of arrival to CT, arrival to tPA, and arrival to groin puncture. Incorporating specially trained stroke-nurses in acute stroke management may be an appropriate use of personnel without negatively impacting stroke care.