Abstract WP72: National Assessment of Trainee and Non-Vascular Neurology Acute Stroke Decision-Making at StrokeNet Regional Coordinating Centers

Abstract

Background: The impact of acute stroke treatment changes, including development of Vascular Neurology, advances in neuroimaging, and endovascular treatment (EVT), on stroke team trainee utilization and decision-making are unknown. For insight into high-performance teams, we surveyed StrokeNet Regional Coordinating Centers (RCCs). Methods: A confidential, self-administered, pilot-tested survey was distributed to the site PIs of all 27 StrokeNet RCCs. The survey assessed in-person acute stroke response staffing, involvement of trainees, decisional autonomy, and attitudes regarding decision-makers. Absent data fields excluded. Descriptive statistics presented. Results: 18 of 27 RCCs completed the survey (gross response rate 66%). 67% (12/18) reported trainees (Resident and/or Fellow) always respond to ED and inpatient activations and 39% (7/18) that trainees always respond to EVT activations. 44% (7/16) and 27% (4/15) reported Nurse Practioner (NP) and Physician Assistant (PA) involvement in ED stroke responses, respectively. Thrombolytic decision-making authority (prior to attending staffing) rested with Fellows and Residents in 61% (11/18) and 18% (3/17), respectively. No NP or PA independent use was identified (0%). 89% (16/18) reported attending Emergency Physicians did not order thrombolytics prior to stroke team consultation. Apart from Vascular Neurology, which was universally acceptable, acceptability by attending specialty for thrombolytic ordering was: Emer Med (88%), Gen Neurology (75%), Neurosurgery (33%), Fam Med (12%), Int Med (11%) and Radiology (6%). Acceptability for EVT decisions was Neurosurgery (94%), Gen Neurology (59%), Radiology (50%), Emer Med (44%), Fam Med (12%) and Int Med (11%). Conclusions: At StrokeNet RCCs, acute stroke teams have significant trainee involvement in both ED and inpatient acute stroke responses and allow trainees significant autonomy. Stroke team involvement likely occurs early in the ED, as few reported attending emergency physicians ordering thrombolytics prior to consultation. Respondents varied in acceptability of different specialties as decision-makers for both thrombolytics and EVT. These findings have potential workforce, education, and training implications.