Abstract TP29: Nurse-led Acute Stroke Process Promotes Advocacy And Treatment Times: A Case Series

Abstract

Background: Reperfusion therapies for acute ischemic strokes are highly time sensitive. Centers across the world have implemented various approaches in treating these patients when presenting to the ED using multidisciplinary team approaches, straight-to-CT, and straight-to-angio suite. Several studies recently published the efficiency of an ED nurse-led stroke process on improving timeliness and decreasing door-to-treatment times. Purpose: Little to no literature has focused on how a stroke RN leading a stroke alert process serves as a patient advocate to assist the decision-making process. Methods: Our CSC built a stroke program using a multidisciplinary team, parallel workflow approach led by a Stroke Responder, filled by a neuroscience RN specially trained to lead the acute stroke process. This case series exemplifies how the Stroke Responder influenced the decision-making process in 2 stroke alerts. Case Study 1: A 60-year old high-profile public figure presented to the ED with mild aphasia. With a low NIHSS, some providers may be reluctant to offer thrombolysis based off risk vs benefit. In this patient’s case, mild aphasia was debilitating to life and career. The stroke RN emphasized this resulting in the patient receiving thrombolysis and making a full recovery to baseline. Case Study 2: For an incoming stroke alert on a 90+ year old, the stroke RN received pertinent patient information and a family contact number from EMS via telemedicine. The stroke RN was able to confirm information with family and transferred call to neurologist for consent of thrombolysis prior to patient arrival. Patient was transferred straight-to-CT upon arrival, administered the thrombolytic within 12 min, and subsequently taken for mechanical thrombectomy in the right MCA bifurcation when procedure was aborted due to NIHSS from 13 to 3. Conclusion: Highly specialized neuroscience nurses assigned to lead a stroke alert process benefit the patient beyond providing effective care coordination and assisting the neurologist with assessments. They can help drive the decision-making process resulting in higher treatment rates and faster door-to-treatment times.