Abstract
Background: Up to 15% of all acute strokes occur while patients are in the hospital, and given their association with other acute conditions, recognition and treatment can be complex. We sought to determine the effectiveness of our nurse-led Stroke Team management of in-hospital stroke within a community hospital setting. Methods: In 2011, our nurse-led Stroke Team was designated as the primary responders for all in-hospital Stroke Alerts. Along with an “In Hospital Stroke Alert Protocol” designed to eliminate barriers and penalties associated with any staff member’s notification of a Stroke Alert, the nurse-led Stroke Team assumed responsibility for hospital-wide education on stroke identification and response, including provision of feedback sessions following the occurrence of a stroke on any inpatient unit. Results: In the 24 months prior to the launch of the new system, two in-hospital stroke patients were treated with intravenous tPA. In 2010, there was 1 intravenous tPA given at 120 minutes, and in 2011 there was 1 intravenous tPA given at 84 minutes. For the first 6 months of 2012 there have been 3 patients treated with intravenous tPA as in-hospital stroke alerts, given at 58, 62 and 38 minutes from time of call respectively. There were no sICH or systemic hemorrhages for any patients. Staff have voiced considerable satisfaction with the process, and no barriers to use of the team have been identified. Conclusion: Nurse-led Stroke Team responders are capable of managing the appropriate and safe use of intravenous tPA treatment for in-hospital stroke patients, while engaging diverse groups of providers in the rapid identification of acute stroke events. Community hospitals should consider development of nurse-led Stroke Teams to complement existing rapid response team efforts.
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