Background and Purpose: In 2012 Saint Francis Hospital, a community hospital was challenged with extended DTN times, low treatment rates of AIS, and no formal inpatient stroke process. In 2012, primary stroke diagnosis volume was 614, only 13 patients were treated with Alteplase for AIS, with a DTN median of 92 minutes. Leaders were concerned with culture of not treating with Alteplase and desired improvement.
Methods: Equip key clinical leaders for both Emergency and Inpatient stroke alerts, using a Neuro ICU nurse in the role of Stroke Alert Nurse (SA-RN). 2012 SA-RN role was created to standardize assessments, NIHSS, administration of Alteplase, and monitoring post-procedure. Efforts were focused on improving time sensitive outcomes, i.e. DTN, LVO assessment, and BP control to mitigate s-ICH. The SA-RN role includes intensive training regarding care of the AIS patient. Audits were used to assure expected outcomes. Education included neuro anatomy and monthly case reviews allowing SA-RN Q&A.
Results: Positive trends seen were (1) increased stroke alert volume, (2) decreased DTN, (3) increased Alteplase administrations. Stroke alert volume, both from the ER and the inpatient units, grew as the staff became more comfortable with stroke identification. Stroke Alerts: 2012 (179), 2013 (322), 2014 (405), 2015 (840), 2016 (1312) Alteplase Administrations: 2012 (13), 2013 (19), 2014 (17), 2015 (73), 2016 (156) DTN median: 2012 (92m), 2013 (76m), 2014 (62m), 2015 (56m), 2016 (44m)
Conclusion: The addition of a clinical leader in the role of SA-RN is recommended for a stroke program with limited resources. The SA-RN allows for consistency of assessment, Alteplase administration, decreased DTN, increased compliance with post-Alteplase monitoring standards, and therefore decreased risk of s-ICH. The SA-RN is for Saint Francis Hospital as a valuable, trusted and consistent member of the stroke team.