Abstract TP64: Nursing Led Intervention Improves Thrombolytic Administration Time by Optimizing Emergency Department Code Stroke Pathways

Abstract

Background: Timely efficient thrombolytic administration has been associated with better clinical outcome in acute ischemic stroke patients. Shortening the time from arrival to code stroke activation can lead to faster thrombolytic administration. Methods: Door to code stroke activation and door to needle times were calculated in consecutive code strokes in the emergency department (ED) from 1/2021-11/2021 Pre and 12/2021-12/2022 Post implementation of “Triage to CT” pathway. Our previous code stroke processes included initial evaluation by the triage nurse, followed by rooming and transferring the patient from triage to the ED room, and then to the CT suite. To improve our process, a staging area was set up where a gurney was placed adjacent to the triage area. This allows rapid assessment and activation of the code stroke protocol. ED staff were educated on sending the patient directly to CT after activation of code stroke by the triage physician. This process eliminates the need to room the patient prior to CT scan. Result: Median Door to Code stroke activation time was significantly lowered after the implementation of “Triage to CT” pathway (17 min to 11 min, respectively, p<0.0001) Conclusion: In our study, “Triage to CT” pathway significantly shortened door to code stroke activation. Optimization of an emergency code stroke process by taking the patient straight to CT suite from the triage area decreases door to code stroke activation time and ultimately door to needle time.