Abstract TP377: Routing for Rapid Results

Abstract

Background: In 2016, the American Heart Association (AHA) published recommendations for emergent large vessel occlusion (ELVO) routing at the International Stroke Conference based on symptomatology and distance from a thrombectomy capable stroke center. Research has shown that a rapid door to puncture and reperfusion time leads to improved patient outcomes in large vessel occlusion patients who meet criteria for thrombectomy. The door to puncture (D2P) benchmark for the AHA Get with the Guidelines data registry and the local Emergency Medical Services (EMS) is 90 minutes. Purpose: The purpose of the project was to find a way to shorten the D2P time in ELVO patients in a 265 bed community hospital. Method: The solution to shortening the D2P time was to identify ELVO patients using an evidenced based stroke severity scale. Collaboration ensued between the thrombectomy capable stroke centers and local EMS to discuss ELVO routing. Previously, stroke patients were identified by EMS only using the Cincinnati Prehospital Stroke Scale (CPSS). The local EMS and the participating hospitals selected the Ventura ELVO Scale (VES), an evidenced based stroke severity scale, to assess positive CPSS patients in the field. Policies were developed, education was rolled out, and ELVO routing went live in October 2017 with two ELVO receiving centers. Our hospital, one of the receiving centers, collected data to follow the trend of D2P times. Results: D2P median prior to going live with ELVO routing was 127 minutes. Only one patient out of fifteen patients between December 2016 and August 2017 had a D2P less than 90 minutes. Between October 2017 and July 2018, after ELVO routing began, ten out of fourteen patients had D2P less than 90 minutes. The median improved to 89 minutes on these patients. All D2P times were then tabulated together to calculate a total median time of all cases. Conclusion: ELVO routing combined with the implementation of the VES enabled us to be successful in shortening our D2P to below the benchmark of 90 minutes. This method may be beneficial in other community based hospitals and counties looking to shorten their D2P.