Abstract P144: Successful Regional Implementation of a Large Vessel Occlusion Screening Tool: An Interdisciplinary Process Improvement Project

Abstract

Introduction: Recommendations have recently been updated to support use of an LVO screening tool to assist in the identification and routing of eligible patients to endovascular stroke centers. Despite the recommendations for the use of an LVO screening tool, the general adoption and implementation is incomplete amongst many stroke systems nationwide. Methods: An interdisciplinary team selected the Vision, Aphasia, Neglect (VAN) tool for use amongst a series of Primary Stroke Centers and freestanding emergency departments. Educational plans surrounding the tool were developed and disseminated to prehospital EMS crews, Emergency Department nurses, and specialty transport crews. Staff education was bolstered utilizing existing EMR-based tools and the development of quick access materials for all personnel. Over a 12-month period, a combination of real time feedback and retrospective chart review were performed to ensure staff compliance and accuracy of LVO evaluations. Results: A total of 687 stroke alert patient were reviewed over a 12-month period—339 were triage arrivals and 348 were EMS arrivals. Initial compliance was low across both EMS and nursing, with only 23% of patients being screened for LVO status during the initial 6 months of implementation but increased to 66% compliance over the last 6 months. Sensitivity of VAN assessments increased from 88% to 93% and specificity increased from 80% to 86% over the same one-year period. Conclusions: Successful implementation of an LVO screening tool requires an interdisciplinary team to adopt a tool that is both user-friendly and validated for detection of LVO. Initial staff education and continuous feedback are essential elements to ensure the overall compliance and accuracy of assessments. Ongoing efforts are underway with a one-year goal of 80% compliance of screening while maintaining a high-level of accuracy. Additional staff education directed at the most common reason for a false positive screening, mistaking dysarthria for aphasia.