Abstract W P226: Pre-Notification of Stroke Symptoms Reduces Decision Times in Acute Stroke

Abstract

Introduction: Both the American Heart and American Stroke Associations recommend pre-notification of potential stroke patients to receiving facilities. Although Emergency Medical Services (EMS) may identify stroke symptoms in the field, initiation of the stroke code process is often postponed until after the patient arrives in the Emergency Department (ED). This could lead to unnecessary delays in assessment and intervention during an acute stroke. Hypothesis: We hypothesized that initiating a stroke code based on advanced notification of stroke symptoms via EMS and a Stroke Code Pit Stop (SCPS) would lead to decreased time of assessment, diagnosticssitics and IV tPA initiation. Methods: A pre- and post-intervention study of 733 patients presenting to 2 EDs in a 5 campus hospital system. Both EDs initiated a SCPS, with pre-notification of stroke symptoms via EMS and stroke code activation prior to patient arrival. Data were reviewed from January 2013-April 2014, comparing code stroke metrics pre- and post SCPS initiation. Inclusion criteria: patients with stroke code initiations in the ED. Exclusion criteria: patients with stroke code initiations after hospitalization. Results: 668 patients metpatients met inclusion and exclusion criteria. Assessment times decreased in all metrics post SCPS initiation. Median time of arrival to time of stroke code initiation decreased from 7 minutes to -11 minutes (39%). Median time from patient arrival to CT imaging and laboratory results both decreased by 12 minutes, from 23 to 11 (48%) and from 41 to 29 (71%) respectively. Median door to IV tPA initiation decreased by 24 minutes, from 73 to 49 (67%). Of the 368 patients in the post intervention time period, 192 patients (52%) arrived to the ED through the SCPS. IV tPA was initiated in 30 patients (16%) arriving to the ED through SCPS, versus 13 patients (7%) arriving to the ED without EMS pre-notification. Conclusions: ED pre-notification of stroke symptoms via EMS and a Stroke Code Pit Stop leads to more rapid assessment, CT imaging, laboratory results , and increased IV tPA usage.