Abstract W P289: Hyper Acute Stroke Nurse Initiative Improves Time to Initiation of Reperfusion Therapy

Abstract

Background: Following Primary Stroke Center designation in 2008, several factors contributed to our hospital's influx of stroke patients. In 2010, the Emergency Medical System covering our county began diverting stroke patients to our facility. In 2011, our 400+ bed medical center became the only organization capable of providing endovascular treatments in the region. This catalyzed another surge of stroke patients transferred to our hospital from outside facilities. Nurses and physicians in the ED noted increased workloads in an attempt to deliver stroke care in a timely manner. In May 2013, the innovative Hyper Acute Stroke (HAS) nurse was created to meet the time sensitive needs of our expanding stroke population. Purpose: The purpose of this initiative is to show the addition of the HAS nurse would improve time to IV tPA and endovascular intervention in stroke care, as well as physician and nurse satisfaction. Methods: With strong administrative and medical support, the Stroke Program Director and 15 critical care neuroscience nurses formed the HAS team. Initial training for the HAS nurse comprised of NIHSS certification and enhancement of neuroscience knowledge. Orientation included training with the Stroke Program Director on inter-facility transfer processes, response to ED Code Strokes, and formation of stroke care algorithms. Upon training completion, daily rotation ensured 24/7 HAS nurse coverage. Pre and post HAS nurse performance measures for IV tPA door to needle (DTN) and door to endovascular intervention times were analyzed. Physician and nursing satisfaction was also surveyed pre- and post HAS nurse involvement. Results: Data refers to the 12 months pre HAS compared to data post HAS nurse. When comparing pre HAS to post HAS time periods, DTN decreased from an average of 82 minutes to 38 minutes, while door to endovascular intervention decreased from an average of 136 to 111 minutes. Physician and nurse satisfaction improved since the institution of the HAS nurse. Conclusions: In conclusion, when responding to Code Strokes or assisting with transfers requiring emergent endovascular intervention, HAS nurse involvement improved time to intervention, and physician/nurse satisfaction.