Background: Frequent neurological monitoring is required for patients who receive IV alteplase and/or thrombectomy. A new stroke neuro check called SNAP (Stroke Neuro Assessment by Providence) was introduced to this regional program. SNAP is defined by four components: (1) level of consciousness (LOC), 1a, 1b, 1c on NIH stroke scale (NIHSS) or GCS, (2) pupil reactivity, (3) movement of all extremities NIHSS 5a, 5b, 6a, 6b, and (4) trending originating symptoms of first NIHSS.
Purpose: Examine SNAP check and provider follow-up compliance at a certified Comprehensive Stroke Center (CSC) with a neurocritical care unit and three certified Primary Stroke Centers (PSC) for all IV alteplase and/or thrombectomy.
Methods: Data between January 2017 and March 2017 from four certified stroke centers were included. One low volume PSC, and patients treated by non-regular nursing staff were excluded from the analysis. SNAP check compliance was calculated as the number of documented SNAP checks divided by eligible opportunities and follow-up compliance as the number of contacted providers divided by all SNAP changes with an associated NIHSS change of 4 or more. Binomial regressions were used to test compliance for conducting SNAP by stroke certification type and components of SNAP.
Results: Of 37 patients included, 59% were female, mean age was 72 (±15) years, and the median ED NIHSS was 9.0 [Interquartile range: 2.0, 17.5]. Provider follow-up compliance was 75% (6/8) and SNAP check compliance was 68% (3,131 completed/4,601 opportunities for 37 patients). There were significant differences in SNAP check compliance by assessment type with highest in LOC and lowest in trending originating symptoms (90% vs. 45%, p<.001). The CSC hospital had a statistically significant higher SNAP check compliance of 82% compared to PSCs which had a combined compliance of 62% (p=0.003).
Conclusions: The CSC had significantly higher overall compliance than the PSCs. However, there is a need for increased compliance with trending originating symptoms at all three hospitals. Our analysis suggest that a neurocritical care unit impacts compliance with a standard stroke neuro check at a Joint Commission certified CSC.