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Purpose: Decrease time from emergency department (ED) arrival to stroke activation and time from ED arrival to ED physician.Background: Delay to stroke alert may lead to a delay in administration of IV thrombolysis. In reviewing our facility’s ED stroke alert data a difference was noted in ED MD arrival time and stroke alert time between patients arriving by emergency medical service (EMS) versus private operated vehicle (POV).In 2015 stroke alert patients that arrived by EMS - median arrival to ED physician time was 5 minutes with median arrival to stroke alert time was 11 minutes; for patients that arrived by POV - median arrival to ED MD time was 16 minutes with median arrival to stroke activation time was 22 minutes. At our rural facility it had historically been an ED physician driven stroke alert process, after reviewing this data we sought to go to an ED nurse led stroke alert process.Methods: Nurse led stroke alert criteria were developed. Activation criteria included specific signs and symptoms of stroke and last known well/seen normal within 4 hours. ED nurses were educated on the new activation process during shift huddles prior to implementation Feb 2016.Results: For Feb-July 2016 stroke activation patients that arrived by EMS - median arrival to ED MD time decreased to 5 minutes with median arrival to stroke alert time decreased to 3 minutes; for patients that arrived by POV - median arrival to ED MD time decreased to 8 minutes with median arrival to stroke alert time decreased to 11 minutes. Additional impact was indentified in the number of average monthly stroke activations - in 2015 there were 20 stroke activations per month compared to 38 for months from Feb -July 2016. Discharge disposition of ischemic stroke activation patients demonstrated changed. In 2015 45 % home, 40% IRF/SNF, and 15% expired/comfort care; compared to Feb - July 2016 63% home, 29% IRF/SNF, and 8% expired/comfort care. Relative reduction of 46% in expired/comfort care.Conclusions: Nurse led stroke activation had a positive impact not only in decreasing the time to stroke activation and time of ED MD to the bedside for both EMS and POV patients but also decreased mortality and increased patients discharged home for patients with ischemic stroke.