Abstract TMP65: The Effects of Standardized Nursing Protocols on Stroke Code Time Metrics - A Multi-Site Telestroke Study

Abstract

Introduction: Emergency Departments utilizing telestroke technology are less likely to meet American Heart Association/American Stroke Association’s recommended Door to Needle goal of less than 45 minutes. The Nursing Driven-Acute Stroke Care (NAS-Care) study tested effects of standardized stroke protocols on key workflow best practices. Methods: Seven non-academic stroke hospitals in the Lone Star Stroke Consortium’s network participated in this prospective, multi-site, baseline-controlled study from February 2015 - December 2018. After three months of blinded baseline data collection, the following interventions were implemented: NIHSS certification, nursing education including mock stroke codes, and a standardized flowsheet for code organization and documentation. The NAS-Care Run Sheet was also used to collect six months of post-intervention data. Results: Six hospitals completed the study. Study enrolment was halted after interim analysis of 447 patients, 180 in the pre-intervention control group and 267 in the post-intervention follow-up. The proportion of patients receiving alteplase was 18.9% (control) and 18.4% (intervention, NS). In the interim analysis, Door-to-ED Provider and Door-to-CT times were reduced after intervention while Door-to-Specialists and Door-to-Needle times were not significantly improved (table). Conclusion: Standardized nursing education and protocols improved staff-dependent initial stroke time metrics in Emergency Departments utilizing telestroke. Additional workflows for telestroke physicians may be required to optimize alteplase administration metrics. Final results of the NAS-Care study will be presented at the International Stroke Conference.