Abstract WP45: A Collaborative Approach to Improving Inpatient Stroke Code Time Target Metrics

Abstract

Much effort and education has been placed on pre-hospital and emergency departments to recognize signs and symptoms of acute stroke and time metrics such as door-to-CT, door-to-needle, and door-to-device. For admitted patients with acute onset of stroke symptoms, our data analysis identified a gap in the timeliness of stroke code activation upon symptoms discovery and subsequent delays in CT initiation and treatment. We evaluated our current process and implemented action plans to enhance the current inpatient stroke code process through focused education and training of staff to improve their recognition of acute stroke, timely activation of stroke code and improved CT initiation and treatment times. In 2021, several cardiology pilot units were selected and neuroscience nurse specialists conducted staff education which focused on recognition of stroke signs and symptoms, code activation criteria and response time targets. A resource binder and checklist were created to guide staff in putting together pertinent elements for communication and documentation. Data was collected on stroke code response times and individual feedback was provided. The group meets quarterly to evaluate progress, discuss opportunities for improvement and highlight best practices and outcomes. The checklist was a useful tool in reminding staff of pertinent information to communicate to the stroke team although form completion is not consistent. In 2021-2022, 54% of stroke codes were called within 10 minutes of symptoms discovery. CTH initiation time within 25 minutes of symptoms discovery was achieved in 16.2% of patients. Data analysis showed an opportunity to improve documentation of symptoms discovery time which were missing in 13.8% of cases. This collaborative approach with the pilot units has increased awareness and focus to the inpatient stroke code process. Opportunities exist to improve time target achievements in CTH initiation, treatment, and documentation of symptoms discovery time. Communication between the stroke team and the patient’s primary team has been identified as an essential factor for continued improvement along with on-going staff education.