Abstract T P272: Improvement in Door to Thrombolytic Time in a Rural Community Hospital

Abstract

Background: Receiving thrombolytic therapy as soon as possible from stroke onset improves chance of complete or near complete neurologic recovery and reduces risk of bleeding. McLaren Northern Michigan (MNM) is a 213 bed nonacademic, regional referral hospital servicing 22 counties. The decision to give thrombolytic therapy at MNM has been the responsibility of the on-site neurologist. Neurological assessment, completion of inclusion/exclusion checklist and verification of stroke onset time were the responsibilities of the Code Stroke neurologist after arrival from home or office. Hypothesis: In a rural community hospital door to thrombolytic time can be reduced by using telephone neurology consultation and a revised multidisciplinary approach to treatment. Methods: Reviewed select Code Stroke data from 2012 to 2013 by a multidisciplinary team: Notification to neurologist arrival in ED Neurologist arrival to decision to treat Decision to treat to start of thrombolytic bolus Door to start of thrombolytic bolus Results: Identified delays: Neurology travel from home or office to ED Completed inclusion exclusion checklist, verification of onset time and neuro assessment by on-site neurologist Mixing of thrombolytic agent by nursing Revised the Code Stroke protocol to shift responsibilities from on-site neurologist to onsite ED nurses and ED physician. Provided with phone consultation with neurology: Documentation and verification ”Last Known Well” time Initial NIH Stroke Scale score and major deficits Results of Inclusion / Exclusion checklist Revised Code Stroke protocol to include a pharmacist at bedside to mix thrombolytic. Conclusion: Door to thrombolytic time was significantly decreased by shifting Code Stroke responsibilities and incorporating a pharmacist at the bedside. There were no major bleeds or adverse events