Background: Earlier stroke alert activations in the emergency department can assemble needed resources quickly in order to shorten treatment delays among eligible patients. We compared the impact of nursing-driven stroke alert activations to EMS- or physician-directed stroke alert activations.
Methods: From January 2015 to June 2016, we reviewed data from all emergency department stroke alert activations at an acute stroke ready hospital. We compared nursing (RN)-driven to paramedic (EMS)- and physician (MD)-driven stroke alert activations to determine rates of stroke mimic diagnoses at discharge and use of intravenous alteplase as well as median door-to-stroke alert, door-to-CT, and door-to-needle times.
Results: There were 175 stroke alert activations during the study period (42 RN, 87 pre-hospital, 46 MD). Stroke mimics prompting stroke alert activations were not significantly different between RN- and EMS-activations (26.2% RN vs 34.5% EMS, p=0.42) but was significantly higher for MD activations (50% MD, p=0.04). Compared to RN-activations, EMS-activations had shorter door to stroke alert (-7 [-10, -5] minutes EMS vs 4 [1, 7] minutes RN, p<0.01) and door to CT (0 minutes EMS vs 14 [8, 16] minutes RN, p<0.01) times; MD-activations had longer door to stroke alert (11.5 [6, 22] minutes MD, p<0.01) and door to CT (20.5 [14, 30.75] minutes MD, p<0.01). Door-to-needle times were similar between RN- and MD-activations (51 [38, 54] minutes RN vs 58 [49, 63] MD, p=0.25); there was a trend towards quicker DNTs for EMS-activations (39 [31, 43] minutes EMS, p=0.057). Rates of alteplase usage were similar for RN-activations (19%) compared to EMS- (12.6%, p=0.43) and MD- (23.9%, p>0.99) activations.
Conclusion: Because of a high level of accuracy, nursing-driven stroke alert activations should be encouraged if indicated in order to shorten stroke alert time metrics when pre-hospital alerts have not occurred. Further studies are needed to examine the impact of nursing-driven stroke alert activations.