Abstract TP343: Achieving Stroke Honor Role Elite Plus by Implementing a 24/7 Neuro-Hospitalist Program

Abstract

Patients with acute ischemic stroke benefit most from intravenous tissue plasminogen activator (tPA) when given as fast as possible. The American Heart Association/American Stroke Association’s (AHA/ASA) highest target is the Stroke Honor Role Elite Plus. This is designed for programs that give IV tPA within 60 minutes in 75% of patients and within 45 minutes in 50% of patients. The current literature however is not clear on the benefit of a comprehensive 24/7 neurohospitalist model on the treatment times of acute ischemic stroke patients with IV tPA. The purpose of our study was to determine the impact of a 24/7 in-house neurohospitalist model on door-to-needle times (DTN) for patients with acute ischemic stroke presenting to the emergency department within 4.5 hours. There were 76 patients treated from 2016-2017 and 83 patients treated from 2017-2018, DTN times were compared before and after implementation of the neurohospitalist program in July 2017. The DTN in 2016-2017 (mean = 53.32 minutes, SD = 29, n =76) was greater than the DTN in 2017-2018 (mean = 44 minutes, SD = 20, n = 83). This difference was statistically significant with p = 0.010 (1 tail). In addition, the improvement in DTN allowed recognition of Stroke Honor Role Elite Plus by the AHA/ASA. Conclusion: Implementation of a 24/7 in-house neurohospitalist program is associated with faster DNT for IV tPA and ability to achieve target AHA/ASA’s Stroke Honor Role Elite Plus.