Abstract P402: Blood Pressure Control Poses Significant Delays to Discharge After an Acute Ischemic Stroke

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Acute ischemic stroke (AIS) patients often experience an extended length of stay (LOS) due to multiple factors, including blood pressure management (BPM). The aim of this quality improvement project was to assess the impact of BPM on LOS in AIS patients. This was a retrospective review of 99 AIS patients randomly selected at a comprehensive stroke center from January to June 2020. The primary outcome was the percentage of patients with LOS observed/expected (O/E) ratio ≥ 0.8. Factors associated with delayed hospital discharge (DHD) were evaluated. Chi-square, student t-test, and Mann-Whitney U test were used as appropriate for analysis. Patients had a mean (SD) age of 65 (14) years, median (IQR) NIHSS 7 (4, 15), HTN history (67%), and were African American (40%), Caucasian (32%), or Other (28%). Table 1 shows types of strokes. Twenty-three (23%) patients received tPA. Forty-five (45%) patients had a LOS O/E ratio of ≥ 0.8. Reasons for DHD included BPM (38%), medical management (33%), stroke management (25%), and disposition (4%). Patients with DHD had an initial mean (SD) SBP of 164 (32) mmHg compared to 161 (33) mmHg in patients with no DHD, p=0.603. Figure 1 shows mean SBP trends. Patients with DHD had a median (IQR) of 2 (0, 3) home BP medications compared to 1 (0, 2) in patients with no DHD, p=0.040. Nine patients (20%) with DHD compared to 7 patients (13%) with no DHD were initiated on a nicardipine drip upon admission, p = 0.416. Oral therapy was initiated on median (IQR) hospital day 2.5 (2, 3) in DHD patients vs. 3 (2, 3) in patients with no DHD, p = 0.951. Median (IQR) number of BP medications on discharge was 2 (1, 2) in DHD patients vs. 1 (0, 2) in patients with no DHD, p=0.170. Reasons for elevated BP included delayed therapy initiation (12%), medication titration (59%), and titration intolerability (29%). Blood pressure management in this cohort was one of the most significant factors in delaying discharge. Protocols should focus on better and faster BPM as a means of reducing length of stay.