Abstract TP331: Inpatient Stroke Codes: 2 Step Response Team

Abstract

Background and Issues: Most Primary Stroke Centers have an acute stroke team (AST) to respond to patients experiencing an acute stroke. Data suggests that inpatient stroke code activations for a not true stroke condition can delay the appropriate interventions or treatments, increase the patient’s exposure to radiation, and increase the inefficient use of personnel time and resources. Our goal was to evaluate the inpatient stroke team activation process and develop a procedure/protocol to provide safe and efficient emergent care for the hospitalized patient who might be having a hyper acute cerebrovascular event. Methods: We developed a POST STROKE CODE EVALUATION tool to collect timeline data and key issues related to all stroke codes called at our hospital from July 2009 through July 2012. Issues were classified as related to leadership, clinical practice, diagnostic imaging delays, equipment, and clinical support. Issues were reviewed by the monthly Emergency Response Quality Committee. Based on the process improvement reviews a 2 step stroke code activation/response team protocol and procedure was developed and implemented for stroke team activations on hospitalized patients. The 2 step stroke team activation allows the case to be escalated to alert and mobilize additional staff (neuro RN, CT technicians, etc.) and to expedite emergent treatment or procedures for the true stroke cases. Likewise the case can be cancelled if the patient is assessed to have a stroke mimic or needs another care team. Results: There were 147 inpatient stroke codes activated from August 3 rd , 2011 through June 30 th 2012 of which 69 (47%) were escalated to team 2 and 68 (46%) were cancelled for non-stroke conditions or other reasons. In 10 (7%) stroke codes the protocol (escalation to team 2 and/or cancelled) was not followed. True strokes were appreciated in 27 (39%) of the stroke team 2 activations. Conclusions: The 2 step stroke code team approach provides the structure for providing safe and efficient care for the hyper acute inpatient experiencing a stroke. Inefficient use of personnel time and resources, unnecessary CT imaging and mobilization of other clinical staff was avoided by almost 50% from implementing this procedure.