Background: In acute ischemic stroke, a blood vessel in the brain is blocked and brain cells die within
minutes; therefore rapid recognition and treatment to restore circulation to the brain is essential.
National guidelines call for a CT scan of the brain to be done within 25 minutes of hospital arrival in
patients presenting with acute stroke to rule out bleeding in the brain. Findings of a hemorrhage would
be a contraindication for thrombolytic therapy. Additional guidelines call for intravenous t-PA (alteplase)
to be administered within 60 minutes of arrival and rapid triage to endovascular therapy in appropriate
patients. Similar goals for rapid treatment should be followed for patients experiencing a stroke while in
the hospital. Urgent treatment with a clot busting medication (alteplase) or with special endovascular
techniques to mechanically remove a clot have been shown to improve outcomes.
Purpose: A performance improvement plan was developed and initiated in January 2015 to improve the
time to CT, time to t-PA administration, and time to endovascular therapy for patients having a stroke
while hospitalized for other diagnoses (In-House Stroke).
Methods: The following revisions were made to current practice: Mock Stroke Code Drills for In-House
Stroke Code responders; creation of an In-House Stroke Code algorithm; addition of CT & MRI screening
forms to In-house Stroke Code packet; development of a Stroke Code criteria checklist to assist floor
nurses; implementation of a feedback loop to Stroke Code team reporting imaging and treatment times
along with patient outcomes; addition of a radiology supervisor to the Stroke Code response team.
Results: “Stroke Code called” to “CT initiated“< 25 minutes improved from 32% in 2013, 30% in 2014, to
60% in 2015. “Stroke Code called” to “IV t-PA (alteplase) administered” < 60 minutes improved from 0%
in 2013, 25% in 2014, to 100% in 2015. “Stroke Code called” to “groin puncture for endovascular
therapy” < 2 hours, 40% for 2013, 43% in 2014 to 50% in 2015.
Conclusion: These interventions resulted in faster CT imaging and treatment times, thereby providing
the patient with the highest quality patient care.