Abstract TP374: Stroke versus Stroke Mimic for Inpatient Code Brain

Abstract

Introduction/Background: Functional outcome from stroke is better if the stroke is identified and treated immediately. The acute stroke pathway at Cedars Sinai is known as Code Brain. This pathway is often activated for inpatients and is a large part of the total number of Code Brain activations. The inpatient Code Brain pathway is inherently a nursing-driven process, most often initially activated by an inpatient nurse. The purpose of this project is to look at the number of Code Brain activations that are truly acute stroke versus stroke “mimics” - common conditions that appear to be consistent with acute stroke, but turn out to be diagnoses that are not stroke related. Methods: Plan: Retrospective patient case review of all in-house Code Brain activations, excluding prehospital/ED activations from January 2015 through December 2015. Do: We meet weekly to asses every Code Brain and evaluate and adjudicate patients Study: Examined results of adjudicated diagnoses to determine how many in-house Code Brain patients had a stroke/TIA diagnosis versus other diagnoses Act: Hospital-wide staff education regarding Code Brain activation criteria, including symptoms of acute stroke/sudden neurologic change in patient status Results: Out of 242 Code Brain in-house activations, 128 were adjudicated to stroke/TIA diagnoses and 114 were adjudicated to “other diagnoses”. Some of the most common non-stroke/non-TIA diagnoses were encephalopathy, migraine and seizure. Conclusions: The national average of over-triage of inpatient stroke activations is a little over 20%. Our study shows that in this time period, 47% of the inpatient Code Brain activations turn out to be non-stroke related diagnoses. There are many factors that can be taken into account for this. However, these outcomes also prove that with the education provided, the nursing staff is empowered to call a Code brain independent of physician advice, which is an excellent example of nursing autonomy. We will continue to monitor this data and educate the staff as needed.