Introduction: Inpatient stroke represents up to 17% of all strokes and should receive the same timely care as patients arriving to the ER, especially in a Joint Commission Certified Comprehensive Stroke Center (CSC). However, evidence suggests there is greater in-hospital delay in evaluation and treatment of inpatient strokes compared with stroke patients in the ER. To reduce symptom discovery to CT time, we implemented standardized language and a single pager for inpatient stroke alerts in a CSC hospital.
Hypothesis: Using standard language to activate the stroke team and a one-call system will reduce symptom discovery to CT times for patients with stroke in the inpatient setting.
Methods: A baseline evaluation revealed a lack of standard language for activating the stroke team (e.g. “Activate Stroke Team”, “Acute Stroke”, “Stroke Consult”, “Internal Alert”) and that the Rapid Response Team (RRT) nurse had to call multiple people to initiate the stroke evaluation process. Key stakeholders formed a workgroup and implemented a hospital-wide education initiative that included the use of standardized language for inpatient activation of the stroke team (“Code Stroke - Inpatient”) and the creation of a pager group with all responders (Stroke MD, RRT nurse, Transport, CT tech, Pharmacy, IV therapy, Chaplain, and NCCU Charge RN). Symptom discovery time to CT was measured pre- (January 2015-February 2016) and post-implementation (March 2016-August 2016). Data were reported as mean ± standard deviation and median [interquartile range], and results were analyzed using an unpaired t-test.
Results: Implementation of standardized language and a single pager reduced the symptom discovery to CT times from 260 ± 421.9 minutes (median = 98 [59,277], n=22) pre-implementation to 39.8 ± 16.5 minutes (median = 36.0 [28, 47], n=20) post-implementation.
Conclusion: A multidisciplinary approach is essential to improving symptom discovery to CT times for inpatient strokes; even high performing CSC’s may lack timely care for this population. Continued research is needed to understand successful methods for equalizing the disparity of stroke care in the ER versus inpatient units.