Background and aim: Shortening door-to-needle(DTN) and door-to-groin (DTG) times without compromising safety, is one of the major goals of reperfusion therapy. A pre-hospital Stroke Code(SC) activation leading to a direct transfer of patients to CT(CT-SC) or to Angio-suit(Angio-SC), bypassing emergency room(ER) in selected patients, has been implemented in our center. To ensure quality and continuous care in this hyperacute process, an expert stroke nurse from the stroke unit is recruited and involved in direct SC transfers. We aimed to assess the impact of the presence of an expert stroke nurse on reperfusion treatment metrics and the safety and feasibility of leaving the Stroke Unit to take care of the SC.
Methods: Direct transfers after SC activation are performed when the arriving patient has RACE score>4 within <6h from symptoms onset. When information is incomplete or unclear the patient is evaluated in ER before CT(ER-SC). An expert stroke nurse is notified in direct SC transfers.
Results: During 2016, 812 patients were transferred to our center after SC activation. 289 patients (35,6%) underwent reperfusion treatment [ER-SC 98(33%), CT-SC 146(50%), Angio-SC 48(17%)].
Expert nurse was recruited to attend 138 SC patients who received reperfusion and to 89 who did not(25 hemorrhagic strokes, 17 stroke mimics, 47 ischemic strokes). Our mean DTN time was 28+/-17min and DTG time 41+/-50min in this period. DTN and DTG times were significantly lower in direct transfers compared with ER-SC (DTN 26,2min vs 37,5min p=0.003 and DTG 41,4min vs 79,2min p<0.001). When the expert nurse was present, those times where even lower (DTN 24,3 and DTG 38,9). Regarding feasibility and safety, no major incidents were found in the stroke unit while expert nurse was attending a SC. Nurse mean time out of the stroke unit was 27+/-11,4min in treated patients, while in not treated was 25min+/-10,3min.
Conclusions: Expert stroke nurse recruitment from the Stroke Unit is feasible and safely helps to improve time indicators in acute stroke reperfusion treatment.