Abstract P845: Impact of T-Pa Pre-Pull Criteria in Collaboration With Telestroke Nurse

Abstract

Background and Purpose: “Target: Stroke Phase III” aims to improve stroke outcomes through the reduction of door-to-needle (DTN) times within 60 minutes in 85% of cases. After a recent data review, DTN times exceeded 60 minutes in the majority of alteplase (t-PA) cases at facilities monitored by our Telestroke (TS) program. With our TS nurses (RNs) being a unique resource to quickly assess Code Stroke patients and identify eligibility for t-PA we were able to implement an ‘Alteplase Pre-Pull’ protocol to instruct the bedside staff to pull t-PA and have it at bedside prior to the teleneurologist’s assessment. Methods: Data was retrospectively collected from July-December 2019 (pre-mixed) and compared to data from January-June 2020 (pre-pulled). TS RNs were educated on pre-pull protocol titled “Less Than 3, Pull Me”. For patients presenting within three hours of symptom onset, TS RN would recommend bedside staff to pull t-PA and have at bedside: this would shave valuable minutes off DTN times if found to be t-PA eligible. TS RN would continue to assess for exclusions. Results: Significant improvements in DTN times due to pre-pulling t-PA. Average DTN time (total-241 patients July-December 2019) improved from 57 minutes to 51 minutes (231 patients Jan-June 2020). Average DTN for pre-pulled patients decreased by 3 minutes from 51 to 48 minutes. Average door to activation decreased from 12 to 7 minutes. Conclusion: Pre-pulling t-PA using the “Less Than 3, Pull Me” protocol significantly reduced DTN times by 6 minutes from 57 to 51 minutes. Activation-to-needle decreased by 1 minute from 46 to 45 minutes indicating that early activation leads to faster DTN times. Early recognition of symptoms by bedside staff is essential to decreasing DTN times. The second half of this study took place amid the COVID-19 pandemic impacting bedside staff due to limited resources. In summary, pre-pulling t-PA has allowed us to shave 6 life-saving minutes off DTN times equating to 11.4 million neurons (Puig, 2018).