Abstract TP494: A Continuous Monitoring Led by a Nurse Working Group Plays a Key Role in the Improvement of Acute Ischemic Stroke Workflow-Metrics

Abstract

Background and Purpose: In the workflow process for the management of acute ischemic stroke (AIS) patients, time is critical to improve functional outcome. Based on the recent 2018 AHA ASA guidelines, median door-to-imaging (DTI) time should be less than 20 minutes and median door-to-needle (DTN) time for tPA administration less than 60 minutes. Our comprehensive stroke center mostly recruits suspected AIS patients following a “mother ship” approach with systematic emergency medical services pre-notification and emergency room by-pass. Based on this specific patient’s care approach, the purpose of our study was to evaluate our capacity to get with the guidelines (GWTG) and to shorten our DTN/DTI times. Methods: In our stroke center, the stroke alert follows a workflow including 15 time-points from call notification to cath lab access. The stroke team work during the stroke alert was evaluated, during two periods of time (oct-to-march and april-to-august) based on its capacity to comply with DTI and DTN recommended median times. Continuous improvement of the workflow was based on prospective data collection analysis and interpretation by a working group led by nurses focusing on knowledge, organization and leadership difficulties identification. Results: From october 2017 to august 2018, 501 stroke alerts were identified in our comprehensive stroke center. Of these, 425 (85%) cases were analyzed. A total of 81 (19%) of the suspected AIS patients received tPA, 44 (10.3%) were treated with combined tPA infusion and thrombectomy and 44 (10.3%) with thrombectomy alone. Median DTI time was 15 min (3-62), median DTN time for tPA administration was 44 min (21-87), median door-to-cath lab time was 64 min (23-140). DTI median time improved significantly between the two time-periods (15,5 (3-62), vs 15(3-50), p= 0,01). Neither DTN time nor door-to-cath lab room time changed significantly during the studied time periods. Conclusion: Our comprehensive stroke center fulfilled the 2018 AHA ASA guidelines for DTI and DTN times. Under the supervision of a nurse working group, shortening of DTI times could be achieved. These findings support the key role of nurses working groups focusing on knowledge and management to improve stroke alert workflow, and finally patient care.