Purpose: Responding to acute out of hospital stroke (OHS) is frequent for most ED nurses. Responding to acute in-house stroke (IHS) is infrequent for most others. Stroke recognition and treatment is often delayed for IHS; staff may attribute symptoms to other causes. Delays can occur due to a lack of knowledge of stroke code procedures.
Initiative: Stroke unit staff developed and implemented a protocol in which the expert stroke nurses from the Stroke Unit’s step down respond to IHS Stroke STAT calls throughout the hospital.
Methods: Initially, responders to Stroke STATs were Neurology residents and the patient’s nurse. In the new protocol, the SD nurse carries a stroke beeper and responds to the IHS Stroke STAT. SD nurses guide and support the bedside nurse, and educate the patient and family. They assist getting to CT scan quickly and promote transfer if needed.
To evaluate the change, times from onset to beeper call and call to CT were compared for the pre and post groups using Wilcoxon Ranked Sum tests; with only 10 patients receiving IV tPA, times for call to treatment are presented descriptively only.
Results: The Stroke STAT Response protocol went live on July 22, 2015. Times for the essential tasks were compared pre- and post-intervention - 8/1/14 - 3/31/15 and 8/1/15 - 3/31/16. There were 85 IHS calls pre-intervention and 80 calls post. Four IHS patients were treated with tPA in the pre-intervention group and 6 post. The median (interquartile range) times per task, percentage of change and p values are below. While no statistical significance was found, decreases in time to treatment are clinically relevant.
Documentation of onset improved from 87.5% to 96.3%.
Discussion: Outcomes of this project have been positive. Time from onset to call, CT and treatment decreased as physicians were able to make treatment decisions sooner. It gives the SD nurses more autonomy as they share their expertise hospital-wide. And it gives patients and families the highest quality care they deserve.