Implementation of an Evidence-Based Prenotification Process for Patients With Stroke to Improve Neurological Outcomes.

Abstract

BACKGROUND: Endovascular mechanical thrombectomy can improve clinical outcomes in eligible patients with acute ischemic stroke (AIS), but its efficacy is time dependent. This quality improvement project aimed to examine whether a revised evidence-based neurological deficit algorithm initiated in the emergency department could reduce door-to-groin puncture time to less than 90 minutes and improve neurological outcomes in AIS patients who received mechanical thrombectomy. METHODS: Retrospective chart reviews occurred between September 2020 and April 2021, which included 25 patients. Clinical and time data were collected from AIS patients who were 18 years and older, presented for care with AIS symptoms, and deemed candidates for thrombectomy for a period of 6 months. A revised neurological deficit algorithm was initiated, and education was presented to appropriate staff. Postintervention chart reviews occurred from August 2021 to January 2022, which included 25 patients. RESULTS: Door-to-groin puncture time did not improve to less than 90 minutes; however, there was a slight improvement in time from 106 minutes in the preintervention to 98 minutes in the postintervention ( P = .534). Although the outcome measures were not clinically significant, there was a statistically significant decrease in response time to acute stroke call down ( P < .01). Door-to-computed tomography also improved, which was 14.42 minutes for the preintervention group and 5.25 minutes for the postintervention group ( P < .001). Finally, the mean National Institutes of Health Stroke Scale on discharge for the preintervention group was 11.92, and that of the postintervention group was 6.05 on discharge ( P < .01). CONCLUSIONS: Implementation of the revised neurological deficit algorithm did not decrease the door-to-groin puncture time to less than 90 minutes. After implementation of the revised neurologic deficit algorithm, there were single variable improvements in several benchmarks, and this is a starting point for future quality improvement projects.