Multidisciplinary Stroke Research Articles

Evaluation of Cost-Effectiveness of a Virtual Multidisciplinary Stroke Care Clinic for Community-Dwelling Survivors of Stroke.

A technologically integrated, multidisciplinary approach to stroke rehabilitation service was delivered and embedded into conventional health care practice. This article reports an evaluation of cost-effectiveness analysis of a new Virtual Multidisciplinary Stroke Care Clinic (VMSCC) service for community-dwelling survivors of stroke. A randomized controlled trial was conducted. Adults with a first/recurrent ischemic/hemorrhagic stroke were recruited from 10 hospitals. Eligible participants were randomly assigned to receive the VMSCC service (individual virtual consultations with a registered nurse, home blood pressure telemonitoring, and unlimited access to an online resource platform) plus usual care or usual care alone. Cost-effectiveness analyses were performed based on incremental cost-effectiveness ratios expressed as incremental cost per emergency admission reduced, and day of hospitalization reduced over the study period. A total of 256 participants (intervention group n=141 versus control group n=115) with complete cost and health care use data were included in the cost-effectiveness analyses. The VMSCC service, on average, resulted in a greater reduction in the number of emergency admission (-0.06 [95% bootstrapped CI, -0.14 to 0.01]) and fewer days of hospitalization (-0.08, [95% bootstrapped CI -0.40 to 0.24]) but incurred a higher total cost of HK$375 (95% bootstrapped CI, -2103 to 2743) compared with the usual care. The incremental cost-effectiveness ratios of the VMSCC service compared with the usual care were HK$6070 and HK$4826 per an emergency admission and a day of hospital stay reduced respectively. The study provides preliminary but not confirmative evidence that the VMSCC service could be more effective but more costly than usual care in reducing health service use. URL: https://www.chictr.org.cn. Unique identifier: ChiCTR1800016101.

Adapting the stroke therapy outcome measure for use by Multidisciplinary Teams: considering reliability

Purpose The Therapy Outcome Measure (TOM) comprises many profession and client group-specific adapted scales based on the International Classification of Functioning Model, used by different Health Care Professionals (HCPs). A new Multidisciplinary stroke TOM scale (MDT Stroke TOMs) was developed by amalgamating the relevant scales. This study aimed to develop a scale to describe patients’ abilities and improve communication and collaboration within the stroke Multidisciplinary Team (MDT). The present study investigated the inter-rater and intra-rater reliability of this adaptation. Materials and Methods The MDT Stroke TOM Scale was developed by combining and rewording four profession-specific adapted TOM scales following iterative trials and discussions leading to an agreed version. 150 stroke Allied Health Professional (AHPs) and nurses were trained virtually in TOM and the MDT Stroke TOM Scale. Ten AHP and nursing raters from five professions evaluated ten composite stroke case studies for inter-rater reliability. Six participated in the intra-rater reliability review of the same three case studies at different time points. Reliability was quantified using intraclass correlation coefficients and measurement error using the smallest detectable change. Results There was good to excellent concordance between the raters in terms of scoring. Raters’ scores were also consistent. The MDT Stroke TOMs is being used consistently across the South West London Stroke Network. Conclusion The Stroke MDT TOMs is psychometrically robust and should assist with improving team work in the rehabilitation of stroke patients and their carers. Future research may use MDT Stroke TOM to promote interprofessional team working and facilitate communication in Stroke Rehabilitation.

Implementation of a Multi-disciplinary Wake-up Stroke (WUS) Protocol at a Comprehensive Stroke Center in a Diverse Urban Community: 2-Year Experience (P2-5.029)

Implementation of a Multi-disciplinary Wake-up Stroke (WUS) Protocol at a Comprehensive Stroke Center in a Diverse Urban Community: 2-Year Experience (P2-5.029)

Confidence in a Crisis: A Pilot Multi-disciplinary Stroke Alert Simulation for First-year Neurology Residents (P8-7.006)

Confidence in a Crisis: A Pilot Multi-disciplinary Stroke Alert Simulation for First-year Neurology Residents (P8-7.006)

Is it possible to make ‘living’ guidelines? An evaluation of the Australian Living Stroke Guidelines

BackgroundKeeping best practice guidelines up-to-date with rapidly emerging research evidence is challenging. ‘Living guidelines’ approaches enable continual incorporation of new research, assisting healthcare professionals to apply the latest evidence to their clinical practice. However, information about how living guidelines are developed, maintained and applied is limited. The Stroke Foundation in Australia was one of the first organisations to apply living guideline development methods for their Living Stroke Guidelines (LSGs), presenting a unique opportunity to evaluate the process and impact of this novel approach.MethodsA mixed-methods study was conducted to understand the experience of LSGs developers and end-users. We used thematic analysis of one-on-one semi-structured interview and online survey data to determine the feasibility, acceptability, and facilitators and barriers of the LSGs. Website analytics data were also reviewed to understand usage.ResultsOverall, the living guidelines approach was both feasible and acceptable to developers and users. Facilitators to use included collaboration with multidisciplinary clinicians and stroke survivors or carers. Increased workload for developers, workload unpredictability, and limited information sharing, and interoperability of technological platforms were identified as barriers. Users indicated increased trust in the LSGs (69%), likelihood of following the LSGs (66%), and frequency of access (58%), compared with previous static versions. Web analytics data showed individual access by 16,517 users in 2016 rising to 53,154 users in 2020, a threefold increase. There was also a fourfold increase in unique LSG pageviews from 2016 to 2020.ConclusionsThis study, the first evaluation of living guidelines, demonstrates that this approach to stroke guideline development is feasible and acceptable, that these approaches may add value to developers and users, and may increase guideline use. Future evaluations should be embedded along with guideline implementation to capture data prospectively.

873 Code Brain Ultra-Early Clinical Pathway for Patient Identification and Management in Spontaneous Non-traumatic Intracranial Hemorrhage Single-Institution Study

INTRODUCTION: Spontaneous non-traumatic intracranial hemorrhage causes high morbidity and mortality. Clinical pathways for the management of acute ischemic stroke are well established but fall short in identifying intracranial hemorrhage, preventing early therapy. METHODS: Using Class 1 recommendations from the AHA/ASA Spontaneous Intracranial Hemorrhage Guidelines, our multi-disciplinary stroke team developed a hyper-acute clinical pathway. Once the hemorrhagic stroke patient was identified, protocolized measures were immediately initiated to lower systolic blood pressure to 140 mmHg, institute factor replacement therapies in coagulopathic patients and anti-platelet reversal when appropriate. Key performance indicators and quality metrics were established to compare post-intervention groups to the baseline cohort. RESULTS: Of 180 patients, 113 and 67 patients were treated pre- and post-protocol, respectively. From pre- to post-protocol, diagnosis of hemorrhagic stroke using the alert increased from 59% to 81%. Anti-hypertensive initiation within 60 minutes increased from 79.5% to 88.7%, with the average time from CT result decreasing from 32.7 to 21.7 minutes. Time to reversal agent decreased from 53 to 23 minutes for pro-coagulation agents and 106 to 55 minutes for DDAVP. Reversal agent initiation within 60 minutes of CT result increased from 66.6% to 100% for pro-coagulation agents and 28.5% to 84.6% for DDAVP. CONCLUSIONS: The initiation of this management protocol for hemorrhagic stroke resulted in a higher proportion of patients being rapidly identified and earlier initiation of anti-hypertensive and hemostatic therapies. These processes are the key to important interventions designed to reduce injury extension associated with intracranial hemorrhage, like “time to thrombolysis” measures for acute ischemic stroke.

Abstract TP121: Using Visual Cues to Improve Dysphagia Screening Compliance in Acute Stroke Patients

Introduction: Dysphagia or difficulty swallowing after a stroke is a common neurological symptom which occurs in 35-67% of all acute stroke patients. Dysphagia can lead to complications such as aspiration, pneumonia, dehydration, weight loss or death. National guidelines recommend dysphagia screening before oral intake in stroke patients to reduce hospital acquired pneumonia. A dysphagia screening tool used by nurses at the bedside that allows for the direct observation of the patient’s ability to swallow is the Water Swallow Test. Upon analysis of patient data, a practice gap was identified in which the dysphagia screening was not performed prior to first oral intake of medication. With collaboration of our multi-disciplinary stroke team to identify opportunities for improvements in the dysphagia performance measure, we hypothesized that if a visual cue was in place prior to first oral administration of medication, we can improve our compliance in the dysphagia performance measure. Method: When a patient presents with stroke symptoms, a purple dot sticker will be placed on the patient’s identification band. This purple dot sticker will serve as a visual cue that will trigger a reminder to the nurse when scanning the patient’s identification band prior to administration of the first oral medication to perform the dysphagia screening. If screening has been performed and the patient passed, the purple sticker will be removed. If the patient fails the screening, the nurse will notify the provider and the patient will be kept NPO (no meds) pending a speech/swallow consult. Upon admission, SBAR handoff to the floor will include failure of dysphagia screening / NPO status and an order for a speech/swallow consult. Result: In 2022, the dysphagia screening compliance was 67%. Following the visual cue implementation, our compliance improved to 100% in June 2023 and 92% in July 2023. Conclusion: Preliminary metrics indicate that this tool has positively impacted our compliance rate. Education to the staff is ongoing. Integration of the visual tool into our hospital guidelines for care of the acute stroke patient is under consideration pending additional analysis of compliance rates.

Abstract WMP28: Developing a New Hospital Into a Primary Stroke Center in Just Over a Year

Background: Stroke programs are often developed and implemented in well-established health care facilities. There is little data on certified stroke programs being established in new hospitals. Our primary goal was to establish a strong culture of engagement in the care of stroke patients from the day the hospital opened. Methods: A multidisciplinary stroke oversight committee was formed, which guided development of the stroke program and integrated leaders from all areas involved with direct or indirect stroke patient care. We began trending processes and overall stroke care based on the Get with the Guidelines (GWTG) STK measures. In this study we compared data from the opening of a 160-bed hospital until achieving Primary Stroke Center (PSC) certification (October 2021 - February 2023) to after certification (March 2023 - June 2023). Our primary outcome was to examine the proportion of IV thrombolysis prior to and after PSC certification. Secondary outcomes included: proportion of door-to-needle time within 60 minutes, proportion of EMS arrival and proportion of patients transferred prior to and after PSC certification. Primary and secondary outcomes were analyzed using backwards Wald binomial logistic regression models which were adjusted for age, sex and NIHSS. Results: Among 300 patients evaluated for potential stroke symptoms, 228 (76%) were assessed prior to PSC and 72 (24%) after. Mean age was 63.15±17.37 years and median [IQR] NIHSS was 1 [0, 2]. GWTG STK measures were achieved (> 85%) both before and after PSC certification. There was a higher proportion of patients treated with IV thrombolysis after PSC compared to before (9.7% versus 2.6%), adjusted Odds Ratio (aOR) = 3.66 [95% Confidence Interval (CI), 1.17 - 11.43], p = .026. There was no statistical difference in the proportion of IV thrombolysis patients treated within 60 minutes of arrival after versus before PSC, (57% versus 20%), aOR = 5.33 [95%CI, 0.38 - 75.78], p = 0.22. Additionally, there were similar proportions of EMS arrival and transfers after compared to before PSC, all p > .05. Conclusions: A successful stroke program can be implemented in a new hospital within a short duration of time.

Organized multi-disciplinary stroke team care improves acute stroke outcomes in resource limited settings; Results of a retrospective study from a Nigerian tertiary hospital

BackgroundEvidence for the impact of organized stroke multidisciplinary teams (MDTs) on outcomes in Africa is sparse. AimTo compare stroke outcomes, before and after the establishment (September 16, 2016) of a pioneer MDT at a tertiary hospital in southern Nigeria. MethodsUsing a retrospective, observational study design, the in-patient record of all stroke patients admitted between September 2014 to September 2018 was retrieved and rigorously reviewed. 155 patients seen 2 years before the MDT were compared with 169 stroke patients seen 2 years after the MDT. Stroke severity at admission and functioning at discharge were assessed using the Stroke Levity Scale (SLS) and the modified Rankin scale (mRS). ResultsMean ages (in years) were 60 pre-MDT vs 59.57 post MDT (p = 0.754). There were more males, 51% pre-MDT vs 54.2% post MDT (p = 0.565). SLS and mRS were not significantly different; severe SLS and mRS pre-MDT, 52.9% vs post-MDT, 49.4% (p = 0.727) and pre-MDT 19.4% vs post-MDT 19.5% (p = 0.685) respectively. More post-MDT patients were discharged alive, pre-MDT,56.8% vs 79.2% post MDT (p < 0.001); had swallow tests, pre-MDT 9.23% vs post-MDT 33.5% (p < 0.001); on secondary prevention, pre-MDT 67.7% vs post-MDT 78.9% (p = 0.023); had more clinic visits, pre-MDT,0.7% vs post-MDT 38.3% (p < 0.001). MDT was independently associated with lower in-hospital mortality on multivariable regression, adjusted odds ratio (OR) (95% Confidence interval CI) 0.17 (0.09–0.32). ConclusionOur results suggest that an organized MDT may improve acute outcomes and reduce mortality in resource constrained settings where there may be no stroke units. These findings need further prospective validation.

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India.

India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

The Evolution and Environmental Benefits of the All Wales Stroke Meeting (AWSM), a Video Conference Multidisciplinary Meeting for Stroke Physicians

Background: The All Wales Stroke Meeting (AWSM) is a multidisciplinary stroke meeting. Stroke clinicians can present cases to review the neuroradiology and discuss the clinical story to further clinical care, seek consensus views on the management in specific rare or complex cases or provide an educational opportunity for the group centred around a rare case or specific feature of the case. Methods: The meeting was created to pool the knowledge of clinicians working across Wales to benefit patient care throughout the country. Here we describe the development, structure and personnel involved in the meeting. There is a focus on the technological requirements of the meeting and how utilising newly introduced IT solutions further improved the meeting’s accessibility. Results: There is a positive economic and environmental impact of delivering multidisciplinary meetings through videoconference technology. The AWSM is estimated to annually save 97.16 days of clinician time and £13,087.18 in travel expenses. We estimate a reduction of carbon footprint of 15,792.38–19,722.44 kg CO2. Conclusion: The AWSM has been an invaluable component of stroke healthcare in Wales since 2009. We think this is an example of where collaborative working and innovative use of technologies can benefit clinicians, patients, NHS services and the environment. Keywords: Stroke, Stroke evaluation, Video conference, Neuroradiology, Continued professional development, Education, Multidisciplinary meeting

Pulmonary Hypertension and Patent Foramen Ovale: A Rare Risk Factor for Stroke (P12-5.022)

<h3>Objective:</h3> To illustrate the importance of a comprehensive and individualized stroke evaluation in young patients with pulmonary hypertension presenting with ischemic stroke. <h3>Background:</h3> Approximately 45% of strokes in the United States are cryptogenic. A common etiology of cryptogenic stroke is a paradoxical embolism through a patent foramen ovale (PFO). Additionally, pulmonary artery hypertension (PAH) is independently associated with 1.5 times higher odds of stroke. It is unclear the compounded risk of stroke in patients with both a PFO and PAH. <h3>Design/Methods:</h3> Case Report and Literature Review. <h3>Results:</h3> A 35-year-old woman with history of PAH presented with vertigo, nausea and headache. Her neurological assessment revealed left-sided dysmetria and truncal ataxia. Brain MRI demonstrated a large left superior cerebellar non-hemorrhagic infarct with partial effacement of the fourth ventricle. She was not a candidate for reperfusion therapy. She required external ventricular drainage. Transthoracic echocardiogram (TTE) showed a dilated right ventricle with reduced systolic function but was otherwise unrevealing. Bilateral lower extremity duplex ultrasound showed no evidence of deep vein thrombosis. The patient was seen in our outpatient multidisciplinary cryptogenic stroke clinic, where repeat TTE with agitated saline injection showed evidence of a PFO. Due to severe pulmonary hypertension, PFO closure was contraindicated, due to potential for worsening right heart function. The patient was started on apixaban for secondary stroke prevention without recurrence of embolic events. <h3>Conclusions:</h3> This unique case report highlights the importance of PFO screening in patients with PAH. Patients with PAH have an increased incidence of stroke, the mechanisms of which are not well understood. In this case, PFO was identified in a patient with severe PAH in our outpatient clinic. Right-to-left shunting in this setting may increase risk of paradoxical embolism. A multidisciplinary approach to cryptogenic stroke patients may facilitate identification of rare mechanisms of stroke as well as improve and personalize secondary stroke prevention. <b>Disclosure:</b> Mr. Arkin has nothing to disclose. Dr. Then has nothing to disclose. An immediate family member of Dr. Ragupathi has received personal compensation for serving as an employee of Merck.

Expediting emergent MRI in acute ischemic stroke by extending CT scout image: a simple intervention to decrease time to treatment (P11-5.010)

<h3>Objective:</h3> We revised our acute stroke CT protocol to reduce time to MRI in acute ischemic stroke. <h3>Background:</h3> “Time is brain” in acute stroke. Patients requiring emergent MR imaging in the emergency department prior to thrombolytic treatment (e.g. wake-up strokes, iodinated contrast allergy, assessment of DWI/FLAIR mismatch) must undergo the MRI safety screen for implantable devices and foreign metallic bodies. Patient factors including neurologic deficits, language barrier, or lack of information on implantable devices make the screening process time-consuming. If patients cannot complete the safety checklist, radiographic clearance with chest and abdomen x-rays is pursued which delays time to treatment. <h3>Design/Methods:</h3> We revised our CT acute stroke radiology protocol to include scout images from the head to the femur to screen for foreign bodies, implantable devices or metallic objects. Standard CTA head and neck scout images previously only extended to the mid-chest. The new protocol obviates need for MRI screening checklist in emergent situations and allows to proceed directly from CT to MRI with the assistance of the radiologist interpreting the scout image. <h3>Results:</h3> Our multidisciplinary stroke team has implemented this change in our emergency department CT acute stroke protocol. The difference in additional radiation exposure is minimal to non-significant; the estimated total radiation dose of the topogram for the head, neck, chest, abdomen, and pelvic regions is approximately 0.24mSv (of which only the abdomen and pelvis are additional in this protocol). In comparison, the radiation dose of a standard abdomen/pelvis radiograph is 0.7mSv. Data collection is ongoing to measure impact on door to needle time. <h3>Conclusions:</h3> Revision of the CT stroke protocol to extend the CT scout from the head to the femur can expedite clearance for emergent MRI in patients who are candidates for thrombolysis or thrombectomy at no significant expense or radiation. This has potential to reduce time to acute stroke treatment. <b>Disclosure:</b> Dr. Aghajan has nothing to disclose. Dr. Gupta has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for •

395 The “Hub-Spoke” Telemedicine Model in a Large Cohort of Stroke Patients

INTRODUCTION: Stroke is a leading cause of death and disability worldwide. According to the World Health Organization, stroke patients should be treated in dedicated stroke units. However, stroke units require multidisciplinary stroke expertise which is usually scarce in rural areas. METHODS: This is a retrospective single-center study encompassing patients suffering from strokes and receiving pre-hospital and in-hospital tele-stroke expertise based on a spoke/hub stroke network. Data from 38 hospital networks between December 2014 and January 2018 were collected. RESULTS: The study cohort consisted of 9702 patients. The majority were females (n = 3556, 55.3%) and the mean age was 67 (67 +16.7, 66.7 - 67.4, 26 -122). Of all patients, tissue plasminogen activator (tPA) was recommended in 1313 (16.3%) patients, and from these, 810 (61.7%) patients were actually given tPA. As for endovascular intervention, only 187 (2.3%) patients underwent mechanical thrombectomy at our institution. CONCLUSIONS: Tele-stroke networks have proven to be a pivotal development in the treatment of strokes, especially those that are remote. With the additional expertise and the shorter duration from onset to diagnosis to treatment, these networks have substantially improved patient care and decreased healthcare costs, avoiding unnecessary transfers from spoke hospitals to hub.

Abstract TMP19: Development Of A Pediatric Stroke Dashboard To Assess Pediatric Stroke Metrics Across A Fourteen Hospital Healthcare System In Southern California

Background: Delays in pediatric stroke recognition and treatment are significant factors contributing to the high rate of morbidity and mortality. There is a lack of national standards for pediatric stroke quality measures. We created a dashboard to abstract pediatric stroke data, including patient volume and established quality measures, from our organization’s 14 hospitals. Methods: The regional pediatric stroke dashboard was created using the organization’s existing adult stroke dashboard as a template. The monitoring system was designed using PowerBI™ and Microsoft Suite™. Dashboard elements were modified to capture pediatric stroke demographics and quality indicators identified by the region’s multidisciplinary pediatric stroke workgroup. Data were abstracted using the organization’s electronic medical record system. Results: The dashboard provides a regionwide, visual representation of this organization’s pediatric stroke data. It is an automated and systematic graphic report describing pediatric stroke volumes and quality metrics. Between 1/2021-6/2022, there were 39 stroke cases: 15% subarachnoid hemorrhage(6/39), 56% intracerebral hemorrhage (22/39), 28% ischemic (11/39). Nine percent of ischemic strokes received a thrombolytic (1/11); 27% had thrombectomy (3/11); 54% were discharged to home (21/39) with no mortalities. The median age was 7.5 years and 66.7% were female. Future dashboard elements will include times for door-to-initial physician evaluation, door-to-Stroke Team notification, door-to-CT or MRI interpretation and door-to-lab results. Conclusion: The Pediatric Stroke Dashboard is an important component of the organization’s regional Pediatric Stroke Program. Leveraging this technology to track and trend the patient volumes and performance measures allows for continuous assessment and identification of opportunities for improvement to achieve pediatric stroke care excellence.

Abstract WMP7: Bridging Thrombolysis For Large Vessel Occlusion: Who Benefits Most? Analysis Of A Prospective Endovascular Therapy Registry

Introduction: Recent meta-analytic evidence supported efficacy and safety of bridging intravenous thrombolysis (IVT) prior to endovascular therapy (EVT) for large vessel occlusion (LVO) but large confirmatory trials are still lacking and optimal candidates for treatment have been a topic of contention lately. Objectives: We aimed to determine a cut-off in treatment times that allows identification of those who would benefit most from bridging IVT. Methods: We analyzed prospectively collected data from consecutive LVO patients who underwent EVT at a tertiary stroke center in Germany from 01/2017 to 12/2021. Patients underwent detailed cardiovascular phenotyping, repeated cranial imaging, and received standardized multidisciplinary stroke unit care. Functional outcome was assessed via modified Rankin scale three months after discharge. Ordinary ridge regression models were built to assess the impact of treatment time cut-offs on functional outcome with adjustment for age, sex, cardiovascular risk factors, baseline NIHSS, cerebrovascular territory, ASPECT score, stroke etiology and carotid artery stenting. Results: Out of 935 patients who had undergone EVT, 170 received bridging IVT (median age 74 [63-82, IQR], 52.4% females), fulfilled our criteria and were included in our analysis. Overall, onset-to-recanalization time but not onset-to-needle time was associated with functional outcome (β1=0.36, 95%CI [0.14,0.58], p=0.001 vs. p=ns). However, those who received EVT with a time delay longer than 190 minutes additionally displayed an association of onset-to-needle time and functional outcome (β1=0.64, 95%CI [0.25,1.04], p=0.02 vs. β2= 2.96, 95%CI [1.32,4.60], p=0.016). Conclusions: Our data indicates that the beneficial effect of swift bridging IVT on functional outcome is most pronounced in cases where initiation of subsequent EVT is substantially delayed.

Abstract 158: An Evaluation Of Stroke Survivors' Self-efficacy In Self-management Using A Stroke Telehealth Service

Background: Previous studies indicate that stroke survivors encounter difficulties in participating in self-management programs because of lack of transportation to rehabilitation centres and unsuitable scheduling. A virtual multidisciplinary stroke care clinic (VMSCC) that builds on the advantages of self-management programs to promote survivors’ recovery and improve caregivers’ outcomes was developed. Methods: A VMSCC was set up to facilitate the interactions between the participants and the healthcare professionals. Participants received a device kit containing a tablet and a clinically validated wireless home blood pressure monitoring device. It was encouraged that survivors monitor their blood pressure daily to take an active role in managing their health. Registered nurses conducted Skype-based video calls with stroke survivors on issues relating to stroke self-management. A nurse reviewed blood pressure data before video calls and used online tools to reinforce self-management knowledge and skills during the video calls. A hotline for psychological and non-urgent health concerns was also maintained by the nurse in the call centre. To determine its effectiveness on stroke survivors' self-efficacy in self-management, a two-arm randomised controlled trial was conducted. We measured self-efficacy outcome using the Stroke Self-Efficacy Questionnaire at baseline (shortly before discharge) and 3 and 6 months after study initiation. Results: We recruited 274 participants from 10 Hong Kong's public hospitals. At 3 months (T1) and 6 months (T2), survivors in the control group demonstrated no significant difference in the change of self-efficacy with respect to T0 (baseline). The generalized estimating equations analysis showed a significant change and estimated additional improvement in self-efficacy in the intervention group at T2. Discussion: VMSCC's intervention was based on self-efficacy theory, which identified perceptions of personal capability as a significant variable associated with stroke outcomes. The development of a self-management program based on the self-efficacy theory was further supported by significant improvements in self-efficacy in the intervention group in this study.

Abstract TP25: Implementing Stroke Systems Of Care Within A New Hospital

Background: Stroke programs are often developed and implemented in well-established health care facilities. Stroke coordinators and nurse navigators are essential leaders to ensure success of a stroke program. We aimed to establish strong culture of engagement in the care of stroke patients from day one of a new 160-bed hospital, by hiring a stroke coordinator and navigator to assist with developing a stroke program prior to opening the hospital. Methods: Five months prior to opening a stroke coordinator was hired and navigator was assigned to coordinate post-acute stroke care. A multidisciplinary stroke oversight committee was formed, which guided development of the stroke program and integrated leaders from all areas involved with direct or indirect stroke patient care. In the months preceding go-live; policies and order sets were implemented, stroke alert processes, specific to each unit, with scenarios were reviewed. All nursing staff completed eight hours of stroke education, including NIHSS certification prior to go-live. Additionally, six mock stroke alerts were completed with the assistance of our simulation and training center. Results: One hundred twenty-two patients presented and were diagnosed with stroke between hospital opening on 09/30/2021 and 06/30/2022. The majority of patients were diagnosed with acute ischemic stroke (AIS) or transient ischemic attack 115 (94.3%), age was 69.1±14.8 years and median NIHSS was 1 [IQR, 0 - 2]. Two patients were recommended for and received AIS treatment; one IV thrombolysis and one endovascular stroke thrombectomy. Thirty four patients were added to the stroke care pathway and closely followed for 90 days. The hospital was 100% compliant with all Get with the Guidelines (GWTG) STK measures, with the exception of CSTK-01 NIHSS at 78%. Additionally, all GWTG achievement measures and quality measures achieved at least 93%, except for dysphagia screening which was at 86% compliance. Conclusions: Developing a stroke program by integrating a stroke coordinator and navigator prior to hospital opening facilitated best practices for stroke systems of care from day one. This allowed a brand-new hospital to achieve similar levels of compliance on key GWTG measures compared to other stroke certified hospitals.

Approach-oriented Physiotherapeutic Management of a Patient with Right Thalamic Bleed: A Case Report

Rehabilitation is essential for stroke recovery. Professionals with experience in stroke rehabilitation from the different fields should make up a basic multidisciplinary stroke rehabilitation team. A stroke is the sudden loss of blood supply to the brain followed by a neurological deficit for more than 24 hours. A 42-year-old male patient presented with chief complaints of sudden weakness over one side of the body, slurred speech and blurred vision. The patient showed typical features of stroke-like tonal abnormalities, altered sensorium, diminished reflexes, reduced range of motion and strength. Magnetic Resonance Imaging (MRI) showed bleeding in the right lenticular capsular, basal ganglia and intraparenchymal part of the thalamus. The physiotherapy treatment started from the Intensive Care Unit (ICU) itself for better results with the collaboration of neurosurgeons and nurses, after the surgery. The Proprioceptive Neuromuscular Facilitation (PNF) approach and Rood’s approach were used to generate neuroplasticity as early as possible. The motor relearning program helped to regain the movements. Various outcome measures like the National Institute of Health Stroke Scale (NIHSS), Brunstorm grading, and Barthel index showed many crucial changes in tone, strength, balance, and coordination that improved the patient’s Quality of Life (QoL). Also, speech therapists and neuro-optometrist play an important role during rehabilitation.

QLTI-11. IMPROVING ACUTE STROKE RESPONSE AT A COMPREHENSIVE CANCER CENTER: A MULTIDISCIPLINARY HOSPITAL-BASED QUALITY IMPROVEMENT PROJECT

Abstract BACKGROUND Stroke is common in patients with malignancy, but cancer patients in treatment have contraindications to intravenous (IV) tissue plasminogen activator (tPA). Advancements in endovascular therapy (EVT) has expanded options for acute stroke management . Memorial Sloan Kettering (MSK) is a cancer center without a public emergency room. Acute stroke management occurs inpatient or in urgent care center (UCC). We determined a need for rapid identification and management for acute strokes in our patient population. METHODS We developed a multidisciplinary Acute Stroke Pathway relying on activation of our hospital’s rapid response team (RRT), neurology, radiology, nursing support, patient escort services, and pharmacy. We initiated hospital-wide education around stroke symptoms and the pathway. All stroke activations are reviewed by Neurology bi-weekly for real-time feedback. Metrics include the times of symptom identification (“door time” = UCC check in or symptom discovery for inpatients), evaluation, head computed tomography (CT), labs, and administration of IV tPA. Times are compared to our 2016 institutional baseline data and National Institute of Neurological Disorders and Stroke (NINDS) benchmarks. RESULTS Since implementation of the pathway (6/11/2018) through Q1 2022 (3/31/2022), there were 551 acute stroke activations, 13 IV tPA administrations, and 48 patients transferred to a comprehensive stroke center for consideration for EVT. Average 2021 door-to-evaluation time: 8 mins (baseline: 18 mins, NINDS: 10 mins), door-to-stroke team: 11 mins (baseline: unknown, NINDS: 15 mins), door-to-CT: 33 mins (Baseline: 95 mins, NINDS: 25min), door-to-CT interpretation: 34 mins (baseline: 251 mins, NINDS: 45 mins), door-to-labs: 50 mins (baseline: unknown, NINDS: 45 min), door-to-IV tPA: 62 mins (baseline: unknown, NINDS: 60min). DISCUSSION The patient population at MSK is distinct from most hospitals. Patients with cancer have a higher incidence of stroke but are unlikely candidates for intervention. Inter-professional collaboration resulted in early stroke care in oncology patients consistent with NINDS benchmarks.