Abstract TP394: The 3- R’s of a Stroke Program Recognize Staff, Raise Alteplase Administration, Reduce Door-to-Needle times

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Background: Early recognition of an acute stroke with timely administration of Alteplase has been shown to reduce disability by as much as 30% at 90-days. The American Heart Association/American Stroke Association endorses Alteplase be administered as quickly as possible. Emergency Department (ED) staff engagement is key to early recognition and rapid treatment of the acute stroke patient.Purpose: The purpose of the Stroke Recognition Dinner was to strengthen ED staff engagement in the Stroke Program by promoting rapid assessment and treatment of the acute stroke patient. Reducing Alteplase door-to-needle (DTN) times leads to improved patient outcomes.Methods: Tracking delivery times revealed delays and lost opportunities in Alteplase administration in the ED. DTN times were analyzed before and after the recognition dinner by graphing times and comparing results. The results indicated the percentage of patients receiving Alteplase increased while the DTN times decreased after the March 2016 recognition dinner. Physicians and Nurses have formed a genuine excitement for rapidly assessing and treating the acute stroke patient.Results: There has been a 25minute reduction in overall DTN times from 3rd quarter 2015 (July) (n = 2) to 3rd quarter 2016 (July) (n = 6). Times from 1st quarter 2016 (n = 12) to 3rd quarter 2016 (July) (n = 6) produced a 13minute reduction in DTN. Alteplase administration increased from 14.7% 2nd quarter 2015 (n = 15, d = 102) to 16.9% (n = 18, d = 106) 2nd quarter 2016.Conclusion: Recognizing and rewarding Emergency Department staff improved staff engagement thereby increasing Alteplase administration, decreasing DTN times, and improving patient outcomes.

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