Background: Between July 1, 2016 and July 31, 2016, there was a significant delay in the initiation of care for patients presenting to the Emergency Department with signs and symptoms of stroke. Applicable metrics for this population include; arrival time to triage complete, arrival time to provider, arrival time to code stroke activated, dysphagia screen completed, reason for no Alteplase documented, and National Institutes of Health Stroke Scale documented. Overall goals for these metrics were being met 76.67% of the time.
Purpose: The purpose of this process improvement project was to improve outcomes and metrics related to patients arriving to the Emergency Department through triage with signs and symptoms of stroke.
Methods: The Stroke Program Manager, Emergency Department Leadership, and the Emergency Department Shared Governance Council, worked together to propose a change to the triage process. Goals were established for; arrival to triage complete, arrival to provider, and arrival to activation. Education on stroke signs and symptoms was provided to all ED staff. A “First Look Nurse” position was introduced in the lobby of the Emergency Department and nursing activation of “Code Stroke” with overhead paging was initiated at time of triage. All metrics were reported out on a weekly and monthly basis to all department staff including physicians.
Results: Between September 1, 2016 and December 31, 2016 goal attainment improved to 93.33% and has been sustained over 90% over the last 6 months. Average arrival to triage time decreased from 7.75 minutes to 4.6 minutes, and arrival to “Code Stroke” activation decreased from an average of 33 minutes in July of 2016 to 13.5 minutes in December of 2016.
Conclusion: This process improvement led to a timelier triage process and increased competence in identifying stroke patients who may be eligible for thrombolytic therapy and endovascular treatment.