Abstract P147: Unanticipated Benefits of a Large Vessel Occlusion Screening Tool in a Primary Stroke Center

Abstract

Introduction: Use of an LVO screening tool to triage patients suspected of having an LVO and expedite transfer to an endovascular capable stroke center (ESC) has some benefit for patients within 15 minutes of an ESC. The benefits of using an LVO screening tool amongst Primary Stroke Centers (PSC) that are geographically isolated from an ESC is of less clear benefit. Methods: The implementation of the Vision, Aphasia, Neglect (VAN) LVO screening tool at a regional series of PSCs and freestanding emergency departments was accomplished in anticipation of pursuing thrombectomy-capable certification at one of the facilities. The use of VAN was incorporated into a tiered stroke alert system to identify patients eligible for endovascular treatment up to 24 hours. Retrospective data was collected and assessed for pre and post implementation time metrics: workflow timestamps, volume of treated and transferred patients, mimic and complication rates, median door-to-needle times, and median door-in-door-out times. Results: The 12-month calendar year prior to and immediately following VAN implementation was reviewed and included final diagnosed ischemic (n=469) and hemorrhagic (n=96) patient volumes. Implementation of VAN was associated with reductions in median door-to-transfer times from 143 to 122 minutes and median door-to-needle times from 48 to 38 minutes. Thrombolytic treatment rates increased by 5%, mimic rate decreased by 5%, without significant changes in thrombolytic complications. Conclusions: In conclusion, use of VAN as an LVO screening tool in a Primary Stroke Center which is geographically isolated from an ESC was associated with an unanticipated improvement of multiple program metrics including reduced door to transfer times, reduced door to needle times, increased percentage of patients treated with thrombolytics, and increased staff satisfaction and engagement. These unanticipated benefits are likely the result of a combination of factors including increased staff awareness of stroke symptoms and optimization of regional stroke alert workflows that occurred in conjunction with LVO implementation.