Abstract
Background: Successful development of a Comprehensive Stroke Center (CSC) requires resources to meet the certifying body requirements including 24/7 on site coverage of neurocritical care as well as provider resources to support the clinical care on off hours. Non-academic centers may be challenged to meet these needs. PURPOSE: We analyzed the impact of designing and implementing a hybrid stroke/neurocritical care Advanced Practice Provider (APP) service. Methods: A 24/7 APP service was recruited, hired and trained from January 2017 through full implementation in January 2018. APP training included a 12 week orientation with a well-developed neuro critical care center, stroke service training with two CSCs, and Emergency Neurological Life Support certification. Their role was to provide consultation for all stroke alerts as well as in-house clinical management of all stroke patients on service and/or requiring neuro critical care services in the ICU. Stroke attending and fellow physicians continued in a partnership and supportive role. Results: Through retrospective analysis outcomes were compared Pre (January 2017-June 2017) and post(January 2018 - June 2018) Implementation. Primary outcomes measured included length of stay (LOS), compliance with quality metrics, order set utilization, door to needle times, and door to puncture times Transferred patients accepted from other facilities on off hours was also tracked. The results are displayed in the table. Conclusions: These results demonstrate that an APP driven stroke and neurocritical care service is feasible and can lead to improved care such as better compliance with stroke CSC measures including the time specific measures indicating quicker face to face assessments, improved documentation of severity scores, increased standard order set usage, enhanced inpatient stroke alert response, and increased presence with families and nursing staff which improved communication on all shifts.
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