Abstract WP370: Breaking Barriers for Fast Acute Stroke Treatment

Abstract

Background: Timeliness of acute stroke treatment is imperative. Our 384 bed, Midwestern community hospital seeks to treat ischemic stroke tPA patients within 45 minutes of arrival. However, individual staff attitudes toward use of tPA, early treatment and teamwork appeared to be barriers to timely treatment. Purpose: To understand what the barriers are for fast treatment and to give staff tools to overcome. Methods: A carefully designed, but brief, set of survey questions concerning individual views and attitudes toward the timeliness and smooth treatment between EDP/ED nurses/Neurology was completed by EDP’s, ED Nurses and Neurologists. The data from this survey was analyzed and provided information to implement changes: 1] Immediate and collaborative feedback reporting timing and outcomes; 2] Provision of a stroke-alert algorithm attached to tPA; and, 3] Accessible education information for patients and family. Results: 56 staff completed the survey pre intervention (PRE) and 72 post intervention (POST). In most cases the barriers were reduced POST. Top barriers identified were: Slow ED to Neurology Contact time PRE 38% and POST 21%; EDP reluctance to treat PRE 32% and POST 18%; Difficulty identifying stroke patients PRE 30% and POST 26%; Losing track of time PRE 29% and POST 19%; Delay due to time to educate patients PRE 18% and POST 19%. Treatment times PRE were an average of 52 minutes door to needle and POST an average of 45 minutes. Door to neurology contact was PRE an average 20 minutes and POST an average of 11 minutes. There was a shift of the EDP’s attitude towards tPA use for acute stroke. PRE 50% answered that tPA use for stroke is not based on existing science. POST this was reduced to 20%. Conclusions: While treatment time, neurology contact time, and reported barriers were improved, the clear shift in EDP collective attitude toward tPA was most important. Keeping stroke at the forefront by communicating through collaborative feedback reports appeared to keep staff engaged and accountable. Keeping algorithms and tPA education material immediately available also assisted in our treatment goals.