Background: In the advent of electronic medical records (EMR), emergency departments (ED) are challenged to include communication with inbound Emergency Medical Services (EMS) within the medical record. Using standardized documentation to guide and capture this critical communication may impact early activation of the stroke team and improve ‘Door to CT’ times. Starting with the “Pre-Notification” measure in Get With the Guidelines (GWTG), our team set out to improve this measure, then evaluate its impact on early stroke team activation and imaging timelines.
Purpose: To utilize a standardized template in the EMR to improve the GWTG Pre-Notification measure by 30% and evaluate its impact on early stroke team activation and imaging.
Methods: Initially, the team agreed that clear criteria for stroke team activation were needed. Once established, a standardized template was designed within the EMR. This included point of care glucose, neurological symptoms, cardiac rhythm, time ‘last known well’, and establishment of IV access/labs drawn. The communication nurses, designated to receive incoming EMS calls, were instructed on the use of this standardized template to guide and record communication for incoming stroke patients. Education and feedback were also provided to EMS providers so that they could anticipate required information and ensure that appropriate care occurred in the pre-hospital setting.
Results: The “Pre-Notification Measure” improved from 29%-77%, early stroke team activation improved from 45% - 73%, and median ‘Door to CT’ time improved from 25 minutes - 18 minutes. (Figure).
Conclusions: Using a standardized template in the EMR improves expectations of care for the ED and EMS providers. This translates into better scores for the GWTG “Pre-Notification” measure, as well early stroke team activation and imaging timelines.