Abstract WP449: Code Swarm Decreases Neuro Interventional Door to Groin Times

Abstract

Background: Each minute of an untreated large vessel occlusion in an ischemic stroke patient can result in the death of 1.9 million neurons. Decreasing the time from stroke onset to the time of treatment is critical to preserving a patient’s cognitive function and improving the long-term outcomes. Thrombectomy using stent retrievers is now leading to faster and more complete reperfusion. This treatment is reflected in the new Target: Stroke Phase III campaign to decreased door to groin times for eligible acute ischemic stroke patients. At University Hospitals Cleveland Comprehensive Stroke Center the time period of patient arrival into the procedure room to obtaining groin access was identified as a contributor to delays in treatment. Hypothesis: A larger number of Interventional Radiology (IR) nurses and technicians responding could have a significant impact on decreasing the time required to prepare a patient in the interventional room for a thrombectomy if there was a unified alert system and process. Methods: In March 2019, a process was initiated to call a “Code Swarm” on the Vocera ™, a peer to peer departmental messaging system. This “Code Swarm” notifies all available trained IR staff to convene in the IR procedure room and assist in the patient preparation for the exam and intervention. Delegation of necessary tasks are assigned by the IR nurse, to include patient education, patient assessment, vascular access, hand off report, cardiac monitoring, and medication administration. Rapid patient preparation allows for faster “IR door to groin” access and treatment. Results: Data for a 9 month period that included 55 patients that underwent a mechanical thrombectomy was analyzed. Baseline 6 months data prior to the implementation of Code Swarm demonstrated an average IR door to groin access time of 26.6 minutes. After the implementation of Code Swarm, the data demonstrated an improvement down to an average time of 10.3 minutes. This is a 39% decrease in the IR door to groin access times. Conclusion: Unified alert system and expectation of all hands on deck exhibits a Magnet culture of nurses who evaluate and reorganize the nursing practice environment to achieve high quality patient outcomes and improve care efficiency.