Abstract WMP25: Implementing a Rapid Response Model to Improve Efficiency of In-Hospital Stroke Code Processes

Abstract

Introduction: In-hospital stroke (IHS), which occurs during hospitalization for other conditions, presents unique challenges and complexities. Studies have shown IHS is associated with worse patient outcomes, e.g., higher morbidity and mortality, compared to community-onset stroke treated in the emergency department. Time from initial symptom recognition to diagnostic imaging is critical for implementing first line therapy. During IHS, efficient and consistent performance of time-sensitive treatments relies on well-defined roles and parallel processing of tasks. Method: A QI initiative aimed at reducing time from initial stroke symptom recognition to initiation of a non-contrast CT (NCCT) scan was implemented at the start of FY 2022 at our CSC. Focus included broad education of all hospital personnel and their defined role in IHS recognition and care. Program analysis included retrospective and prospective data collected from patients’ electronic health records (EHR) and daily EHR audits for comparison of pre- and post-implementation data (FY 2021 and FY 2022, respectively). Data collection included time of stroke code call (symptom recognition), time of NCCT, and compliance of turn-around-time (TAT) between data points, with a goal of < 20 minutes. Results: An overall increase in the number of IHS code calls between FY 2021 and FY 2022 (n=82 vs. n=106, respectively) was appreciated, with an overall decrease in mean time from stroke recognition to NCCT ( M =22 vs. M =18.3 minutes, respectively). Overall compliance of TAT between these two data points increased from 53% to 73% post QI implementation. Additionally, we experienced an improvement in IHS activation time to IV thrombolytics administration time with a median time of 64.5 minutes (FY 2021, n=8) to median time of 59 minutes (FY 2022). Conclusion: Implementing a system wide QI initiative for IHS with well-defined roles and expectations, and parallel processing of tasks can lead to early recognition and activation of IHS code calls. Improved symptom recognition, code activation, and coordinated response efforts improved time and compliance to initial imaging as well as time to thrombolytic administration in our patient population.