Abstract TP61: 15 Minutes Can Save Lives: An EMS Direct to CT Protocol for Stroke Patients in the Emergency Department

Abstract

Purpose: To evaluate an Emergency Medical Services (EMS) Direct-to-CT Protocol developed and implemented to reduce diagnostic and treatment times in eligible adult patients presenting to the Emergency Department (ED) with an acute ischemic stroke (AIS). Methodology: A pre-and post-implementation design at a primary stroke center in a New Jersey small-scale urban city. The chart review consisted of 54 records of patients presenting to the adult ED by EMS with a stroke activation from September 2022 to November 2022 and was measured to determine the time of provider evaluation, door-to-Code Stroke time, door-to-CT (DTCT) time, and door-to-needle (DTN) time. Results: 50/101 (49.5%) pre-and 4/17 (23.5%) post-implementation charts met inclusion criteria. Statistically significant decreases occurred in the post-implementation period for door-toprovider evaluation time (median, 11.5 minutes vs 3 minutes; P = .026), door-to-Code Stroke activation time (median, 18.5 minutes vs 3.5 minutes; P = .002), and DTCT time (median, 21 minutes vs 7.5 minutes; P = < .001). Although median DTN time was reduced, it was not statistically significant (median 72 minutes vs 53 minutes, P = .060). The rate of patients with a DTN time of < 60 minutes was 50% higher in the post-implementation group. Implications for Practice: This project demonstrates improvement in the knowledge of the current American Heart Association and American Stroke Association recommended guidelines in stroke management and treatment. This program evaluation identifies improvements in DTCT and DTN times with the future integration of this protocol into a policy. The most cost-effective intervention for an acute ischemic stroke is early treatment with thrombolytics.