Abstract W P277: Specialized Teams React on Key Examinations: The Impact of Triage in Acute Ischemic Stroke

Abstract

Specialized Teams React On Key Examinations: The Impact of Triage in Acute Ischemic Stroke Category: Emergency Care/Systems Background and Purpose: The Brain Attack Coalition recommends the initiation of thrombolytic therapy in ischemic strokes within 60 minutes of hospital arrival. Poor compliance in our Emergency Department with door to needle (DTN) challenged us to identify care strategies to rapidly identify, evaluate, and implement care in the acute stroke population. In 2012, we integrated resources caring for ST Elevation Myocardial Infarctions (STEMI) and acute strokes to form the Time is Tissue unit that would result in improved compliance. Methods: Specialized training was provided to Emergency Medical Services (EMS) and the STEMI unit staff in acute stroke recognition and care. Acute stroke patients identified by EMS bypassed standard triage and the Time is Tissue unit was responsible for care from arrival through disposition. Results: A retrospective and concurrent chart review was performed from January 2011 to June 2013 on 232 patients (100%) receiving rt-PA. The research confirmed that specialized teams increased compliance for DTN. An unexpected finding was rt-PA volume increased 117% when comparing 2011 to 2012 without a significant change in presenting ischemic stroke volume. Conclusion: Our strategy of aligning processes and utilizing specialized teams to meet time and quality goals resulted in exceptional gains in the volume of patients identified to receive rt-PA and improvement in DTN times.