Abstract WMP113: Improvement of Door-to-Groin Puncture Times in Stroke Codes

Abstract

Background: Stroke is the leading preventable cause of disability in the United States and the 5th leading cause of death. There are approximately 800,000 strokes each year. In 2010, the estimated cost of stroke was $34 billion. Regional targets for door-to-treatment times of patients with acute ischemic stroke have become more stringent as re-establishing blood flow quickly in these patients is the key to positive results. Based on evidence from recent endovascular trials, the San Diego County Stroke Consortium set the target for Door-to-Groin Puncture time ≤ 90 minutes in 50% of cases with proven large vessel occlusion. Although Sharp Grossmont Hospital (SGH) has had a long-established process of rapid triage, evaluation and management within the Emergency Department and In-House, the lack of consistency among responders necessitated establishing a standardized work flow. Purpose: A performance improvement plan was developed and initiated in November 2016 to improve the time to endovascular therapy for patients having a stroke. Methods: The following revisions were made to current practice: created the role of the Stroke Code Nurse; created Stroke Code algorithm; developed a Stroke Code criteria checklist; utilized Telestroke; implemented a feedback loop to Stroke Code team reporting imaging and treatment times along with patient outcomes. A specially trained team of 9 RNs provides 24 hour coverage for Stroke Codes, both In-House and in the ED. The Stroke Code Nurse acts as code leader/timekeeper and liaison between multiple departments, thereby decreasing the time it takes to send qualified patients to Interventional Radiology. Results: SHG's Door-to-Groin Puncture ≤ 90 minutes improved from 46% to 60%, surpassing the regional target of 50%, while also seeing an increase from 37 cases in 2015 and 41 cases in 2016 to 57 cases in 2017. Conclusion: Implementing the Stroke Nurse Role and creating a standardized work flow resulted in better identification of stroke patients due to the expertise of the Stroke Nurse, and faster imaging and treatment times. Implementing this process improvement plan provided patients with the highest quality care.