Abstract WP83: Prioritize Rural Routing With Large Vessel Occlusion Stroke Severity Scale

Abstract

Background: As a growing rural Primary Stroke Center (PSC), we found acute stroke patients bypassing a PSC via air care to receive care at a Comprehensive Stroke Center (CSC) without a Large Vessel Occlusion (LVO) severity scale assessment. In collaboration with our local Emergency Medicine Services (EMS), we aimed to initiate a LVO severity scale assessment with routing algorithm to enhance stroke care. Our goal was to improve pre-hospital acute stroke assessments with a standard LVO severity scale and routing algorithm. Further improving time sensitive care and utilizing resources appropriately during a time of hospital diversion and staff shortage. Method: Utilizing stroke guidelines, a standardized LVO scale and routing algorithm were developed and incorporated into Emergency Department (ED) and EMS education and communication. From March 2022 to March 2023, we reviewed all pre-hospital stroke alerts. We compared LVO assessments competed, appropriate routing, and air care activation; as well as, door-to-needle, and door-to transfer times. Results: There were 31 pre-hospital stroke alerts prior to the initiation of LVO assessment and routing interventions from March through June 2022 (Total LVO assessed 23%, bypass PSC with positive LVO assessed 33%, Door-to-needle median 30 minutes, Door-to-transfer median 64 minutes). After initiation of LVO assessment and routing algorithm from July 2022 to March 2023 there were 84 pre-hospital stroke alerts (Total LVO assessed 95%, bypass PSC with positive LVO assessed 100%, activation of air care to PSC with positive LVO assessed 100%, Door-to-needle median 27 minutes, Door-to-transfer 48 minutes). Conclusion: By identifying an assessment gap and providing education with assessment and routing resources, we experienced an increase in LVO assessments, improved routing of the acute stroke patient, along with improved door-to-needle and door-to-transfer times. Initiating and educating ED and EMS staff on a LVO assessment scale with routing algorithm was an effective intervention within our rural services area.