Abstract TP288: Introduction of a 24/7 Acute Care Nurse Practitioner-Based Stroke Code Team Improved Compliance with Time Targets

Abstract

Introduction: An on-site stroke team improves access to IV tPA and speeds assessment of acute stroke patients. The impact of an acute care nurse practitioner (ACNP)-based team to provide 24/7 on-site stroke coverage was studied at a Primary Stroke Center that previously lacked on-site coverage around-the-clock. Hypothesis: We hypothesized that the introduction of 24/7 on-site coverage by an ACNP-based acute stroke team would improve compliance with time targets for rapid assessment of stroke patients. Methods: A single Primary Stroke Center in Honolulu, HI prospectively collected data on acute stroke code activations for the Get With the Guidelines - Stroke clinical database over a 33-month period. We retrospectively analyzed data for consecutive periods of 19 months before and 14 months after introduction of a 24/7 on-site acute stroke code team that included an ACNP as first responder. Data included patient characteristics, target times, and tPA utilization. Results: During the 19-month period prior to ACNP coverage, 200 acute stroke code activations occurred. The mean age of patients was 67.6 years, 51.5% were male, and the mean initial NIH stroke scale score was 15.3 +/- 5.1. Acute ischemic stroke was diagnosed in 47% of acute stroke code activations and 36.2% of those were treated with IV tPA. During the 14-month period after ACNP coverage began, the number of stroke code activations increased to 276. The mean age of patients was 67.5 years, 44.6% were male, and the mean initial NIH stroke scale score was 12.4 +/- 7.2. Acute ischemic stroke was diagnosed in 53.3% of acute stroke code activations and 33.3% of those were treated with IV tPA. After the intervention, door-to-CT-completion time improved from 45.2 +/- 30.1 to 37.8 +/- 20/8 minutes (p=0.192), door-to-lab-result time improved from 42.2 +/- 11.4 to 34.0 +/- 12.4 minutes (p=0.003), and door-to-needle time improved from 60.8 +/- 30.2 to 55.1 +/- 24.3 minutes (p=0.367). After the intervention, compliance with the 60-minute target door-to-needle time improved from 62.1% to 72.3% (p=0.247). Conclusions: Introduction of 24/7 on-site ACNP coverage as first responder for acute stroke code activations resulted in modest improvement of compliance with target times for assessment of acute stroke patients.