Abstract WP148: Implementation of a Hospital Wide Process Improves Rapid Administration of In-Hospital Intravenous Thrombolytics and Endovascular Therapy

Abstract

Background: The recognition of in-hospital strokes (IHS) and their subsequent interventions remain challenging. IHS do not have guideline-based efficiency metrics established. Only 1 in 5 IHS receive treatment within 60 minutes of symptom recognition time (SRT). We aimed to establish a resident physician-nursing collaborative effort to improve IHS time metrics. Methods: We retrospectively compared SRT to bolus time and/or skin puncture time Pre (2010-2016) and Post (2017-2023) implementation of our hospital wide process, which focuses on rapid nursing identification of BEFAST stroke symptoms and notification of the neurology resident physician, who then immediately assesses the patient, validates the last known well time and calls a code stroke if indicated. Chi-square or Fisher’s exact test were used for categorical variables; Wilcoxon’s rank sum test was used for the outcomes of SRT to bolus and SRT to puncture. Result: We identified 196 IHS who received emergent treatment: 58 (30%) in Pre and 138 (70%) in Post Intervention (p=0.05). There was no difference in baseline demographics. SRT to thrombolytic administration significantly improved Post Intervention {49 minutes (IQR: 23-268) vs 82 minutes (IQR: 33-220, p<0.05}; Post Intervention SRT to skin puncture time trended towards improvement {90 minutes (IQR: 33-266) vs 110 minutes (IQR: 52-420), p=0.09}. There were no differences in symptomatic intracerebral hemorrhages between the two groups. Conclusion: The implementation of a hospital wide process that focuses on a neurology resident physician and nursing collaboration greatly improves IHS SRT to thrombolytic administration time with a trend towards improvement in SRT to skin puncture time.