Abstract W P355: Emergency Room Stroke Nurse Facilitator Improves Door to Needle IV rtPA Time in a Rural Hospital

Abstract

The National Institute of Neurological Disorders and Stroke benchmark treatment time for acute ischemic stroke with intravenous rtPA door to needle time is 60 minutes or less. Hospitals identified as Primary Stroke Centers will be required to treat 50% of their patients who qualify for rtPA within that time frame. Acute stroke care requires the skills of a multidisciplinary stroke team with nursing playing a pivotal role in the emergency room setting, including meeting the benchmark for IV rtPA administration. Review of the literature reveals that nurses comprehend the importance of and have a desire to provide timely and quality acute stroke care but there may be barriers to achieving that end including; lack of proficiency with the NIH stroke screen assessment, other emergency department demands and staffing challenges that affect stroke care. As part of the ongoing process improvement program at our 180 bed primary stroke care center in rural northwestern Pennsylvania, we hypothesized a need for an emergency room stroke nurse facilitator to meet the 60 minute door to needle IV rtPA time. Our hospital treated an average of 14 patients per year with IV rtPA from 2010 to 2013. We used a sample population of 31 participants representing all those presenting to the emergency department qualifying for IV rtPA: 13 patients from January to November 2013 before starting the stroke nurse facilitator role, 18 patients from December 2013 to May 2014 after starting the stroke nurse facilitator role. Data was collected from Get with the Guidelines stroke data base. Results revealed that before starting the role of the stroke nurse facilitator, the average door to needle IV rtPA time was 68 minutes with mean time of 70 minutes. After starting the role of the stroke nurse facilitator the average IV rtPA door to needle time was 60 minutes with a mean time of 47 minutes. In conclusion, a stroke nurse facilitator appears to provide improvement of door to needle IV rtPA time in the emergency room setting. Our goal is to maintain the stroke nurse facilitator and follow outcomes to determine if this improvement is sustainable.