Background and Issues: Eliminating treatment delays for acute ischemic stroke patients to meet the national door to needle (DTN) Target Stroke Phase II goals continues to present a challenge for many facilities. Although the Stroke Alert process is usually guided by strict protocols it can still suffer delays from a lack of communication and facilitation to ensure rapid patient assessment and treatment.
Purpose: The purpose of this project was to eliminate Stroke Alert delays related to communication and lack of facilitation by implementing a Stroke Nurse Facilitator (SNF) and allow intravenous tissue plasminogen activator (tPA) to be successfully started in the CT room.
Methods: An interdisciplinary team conducted a Pareto analysis on DTN delays and found communication to be the most common. Communication was also felt to be the biggest barrier to starting tPA in the CT room. The role of a SNF was created and mapped into the Stroke Alert process to overcome these barriers. The role launched in November 2016. Six months later, after the role became an integral part in the Stroke Alert process, the team moved forward with administering tPA in the CT room as part of the process.
Results: DTN was measured in 61 emergency department stroke patients, 34 in the pre-intervention, 12 in the SNF only, and 15 in the SNF and tPA in CT groups. Data were analyzed using the non-parametric Mann Whitney U test. Although not statistically significant due to the small sample size, there was a large improvement in DTN from pre (n=34) to the first intervention group [Z= 11.19, p=.06, d =.84]. The improvement from DTN from pre to the second intervention group was very large and statistically significant [Z= 24.00, p<.001, d = 1.34]. There was no statistically significant difference in the outcome between the two post groups. The total difference between pre and post samples was large and statistically significant (t=4.46, p<.001, d = 1.10).
Conclusions: Successful communication and facilitation is crucial to achieve positive outcomes or process improvements. Implementing a SNF to overcome these barriers could prove to be a successful strategy to improving DTN times for acute stroke patients.