Abstract TP60: Utilization of Rapid Response Team Nurses to Improve In-Hospital Stroke Response

Abstract

Introduction: In-hospital strokes are estimated to account for 2-17% of all strokes. These patients typically have higher mortality, longer length of stay, and higher disability rates than strokes that initiate within the community. In addition, in-hospital strokes often result in delayed symptom recognition and slower coordination of stroke team response. To address this, Rapid Response Team (RRT) nurses have been empowered to lead the Inpatient Stroke Alert process to improve response time. Methods: Beginning in 2016, stroke program leadership in conjunction with frontline RRT nurses worked together to improve the Inpatient Stroke Alert response. A standardized Inpatient Stroke Alert pathway was created and simulated that included empowering RRT nurses to initiate stroke alerts. Quality drilldown emails of each patient receiving thrombolytics began to be sent to frontline teams including RRT to debrief each event. In 2017, a neurohospitalist team and overnight tele-stroke capability was introduced to work alongside the RRT nurse to quickly assess and provide direction on care. Finally, in 2020, a streamlined RRT stroke alert order set was introduced along with an updated nurse-specific stroke alert badge buddy. RRT nurses were integral to these efforts as a small but highly skilled and unassigned team dedicated to response to all critical events within the hospital. Results: Every in-hospital (n=38) and ED stroke alert patient (n=377) that received thrombolytics from 2016 to June 2023 was included in the data. Mean discovery-to-thrombolytic times for in-hospital stroke patients in 2016 was 116.7 minutes (n=3) compared to 71.7 minutes (n=35) for ED stroke alerts. As of June 2023, mean discovery-to-thrombolytic times for in-hospital stroke patients have steadily improved to 52.8 minutes (n=6; vs. ED 38.7 minutes, n=57) in 2022 and 45 minutes (n=1; vs. ED 34.3 minutes, n=47) in 2023. This resulted in an improvement of greater than 60% in discovery-to-thrombolytic times. Conclusions: Development of a nurse-led in-hospital stroke alert process utilizing the RRT nurses has led to vast improvement in discovery-to-thrombolytic times.