Abstract TP480: Standardizing Inpatient Stroke Alert Processes Yields Faster Treatment Times in Inpatient Strokes

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Background: In-hospital strokes account for 6.5%-15% of all strokes. Efficiently managing inpatient stroke alerts is a resource-intensive process involving multidisciplinary teams. Standardized emergency department (ED) stroke protocols have been shown to decrease time from stroke alert (SA) activation to neuroimaging and treatment. At our institution, stroke patients arriving to the ED were evaluated and treated faster than inpatient (IP) strokes, highlighting the need for an improved IP SA process to meet work flow benchmarks established by the American Stroke Association. Purpose: Standardizing the IP SA process will decrease time to CT imaging and neurological evaluation, reducing SA activation to treatment times for IP strokes. Methods: A revised in-hospital SA protocol was implemented 8/2016 to prioritize early neurology notification and CT imaging. A total of 332 inpatient SA cases from 1/2013-6/2018 were analyzed for: SA activation to neurology contact, SA activation to CT image scout film time, SA activation to thrombolytic (tPA) administration and/or groin puncture time in cases where a mechanical thrombectomy was performed. Results: Analysis showed significant improvements to all of the outcome measures: 35% improvement in IP SA activation to CT imaging start time (N= 167 prior to protocol revision; N=165 after protocol revision), 36% improvement in SA activation to neurology contact time, 59% improvement in SA to tPA administration time (N=7 prior to protocol revision; N=11 after protocol revision), and a 10% improvement in SA to groin puncture time for thrombectomy cases (N=6 cases prior to protocol revision; N=6 after protocol revision). A 36% increase in IP tPA administrations might be attributed to rapid consideration of eligibility within the treatment window. Conclusions: Standardizing IP SA processes to remove inefficiencies optimizes work flow across all phases of evaluation and leads to faster treatment times and increased treatment rates. These findings may serve as the basis for large-scale multicenter studies to further validate effective protocols’ impact on patient outcomes.