Introduction: TARGET:STROKE (TS) has established metrics for hospitals to measure the timely administration of thrombolytics. However, these time metrics may not apply to patients who suffer a stroke while admitted to the hospital, since the initial time is the emergency department (ED) door time. The aim of this project was to create metrics and an algorithm applicable to an Inpatient Code Stroke (ICS), and assess a hospital wide education series to improve times to intervention.
Methods: ICS metrics defined by TS were established with the Symptom Recognition Time (SRT) to equate to the ED door time, and assessed pre and post intervention. The intervention was a hospital wide education of stroke symptoms, as well the ICS process. A badge reference card with this information was given to nurses. Data were recorded for 6 months pre and post implementation. Outcomes included SRT to stroke team notification, CT scan initiation and interpretation, thrombolytic administration and groin puncture. Fisher’s Exact and Wilcoxon Rank Sum Tests were used for data analysis.
Results: There were 86 ICS activations (34 pre and 51 post intervention). There was no difference in baseline demographics, and ICS activation based on unit type. Surgical patients were the most common to have an ICS activation (25.8%). There was a strong trend of SRT to stroke team notification being faster post intervention (median: 22 [0-435] mins pre vs. 12 [0-187] mins post, p=0.059). SRT to groin puncture was faster post intervention (median: 131 [0-286] mins pre vs. 67 [38-91] post, p=0.006). There were more patients who had SRT to thrombolytic ≤ 60 mins or SRT to groin puncture ≤ 90 mins post-intervention (4 [33.3%] pre vs. 10 [71.4%] post, p=0.036).
Conclusion: This is the first study to demonstrate that implementation of an ICS algorithm and its accompanying education can increase the percentage of patients who receive thrombolytics and groin puncture for thrombectomy ≤ 60 mins and ≤ 90 mins from SRT, respectively.