Abstract TP368: Improving In-House Stroke Code Imaging and Treatment Times

Abstract

Background: In acute ischemic stroke, a blood vessel in the brain is blocked and brain cells die within minutes; therefore rapid recognition and treatment to restore circulation to the brain is essential. National guidelines call for a CT scan of the brain to be done within 25 minutes of hospital arrival in patients presenting with acute stroke to rule out bleeding in the brain. Findings of a hemorrhage would be a contraindication for thrombolytic therapy. Additional guidelines call for intravenous t-PA (alteplase) to be administered within 60 minutes of arrival and rapid triage to endovascular therapy in appropriate patients. Similar goals for rapid treatment should be followed for patients experiencing a stroke while in the hospital. Urgent treatment with a clot busting medication (alteplase) or with special endovascular techniques to mechanically remove a clot have been shown to improve outcomes. Purpose: A performance improvement plan was developed and initiated in January 2015 to improve the time to CT, time to t-PA administration, and time to endovascular therapy for patients having a stroke while hospitalized for other diagnoses (In-House Stroke). Method s: The following revisions were made to current practice: Mock Stroke Code Drills for In-House Stroke Code responders; creation of an In-House Stroke Code algorithm; addition of CT & MRI screening forms to In-house Stroke Code packet; development of a Stroke Code criteria checklist to assist floor nurses; implementation of a feedback loop to Stroke Code team reporting imaging and treatment times along with patient outcomes; addition of a radiology supervisor to the Stroke Code response team. Results: “Stroke Code called” to “CT initiated“< 25 minutes improved from 32% in 2013, 30% in 2014, to 60% in 2015. “Stroke Code called” to “IV t-PA (alteplase) administered” < 60 minutes improved from 0% in 2013, 25% in 2014, to 100% in 2015. “Stroke Code called” to “groin puncture for endovascular therapy” < 2 hours, 40% for 2013, 43% in 2014 to 50% in 2015. Conclusion: These interventions resulted in faster CT imaging and treatment times, thereby providing the patient with the highest quality patient care.