Background:
Despite an array of available guidelines and research, many organizations continue to seek innovative ways to decrease time delays and enhance their stroke care delivery systems. After dissecting the case of an acute ischemic stroke (AIS) patient cared for in our facility, many delays were noted from onset of symptoms until admission to ED.
Purpose:
The purpose of the HASTe (Hyper Acute Stroke Team) initiative is to utilize a case-study approach to discover pre-hospital and ED delays, and offer quality improvement project ideas that can be used to enhance stroke-care delivery systems.
Methods:
With leadership from the Stroke Program Director, 15 neuro-critical care nurses formed the HASTe to ameliorate delays noted in AIS care. A case-study review of an AIS patient led to a schematic timeline map which demonstrated minutes lost at each area of delay. Identified areas of delay included lack of community knowledge on stroke, preventative delays in Emergency Medical System (EMS) on-scene time, lack of updated AHA/ASA guideline knowledge at an outside facility ED, inefficient transfer processes to our facility for endovascular intervention, and technical delays in electronic medical record entry. All of these factors contributed to time lost for reperfusion therapy.
Results:
Pre-hospital and ED delays contributed to approximately 120 minutes lost. After analyzing these delays, the HASTe initiated several performance improvement projects to address the delays. Community and EMS presentations covering the urgency of stroke were created. Connections were made with outside facility ED educators to offer in-services on AHA/ASA updates. Improved transfer processes were coordinated with local EMS administration and private ambulances. A pre-admitted “John Doe-Stroke” medical record was created for potential stroke patients coming in to our ED.
Conclusions:
A team approach such as the HASTe is an innovative way to integrate knowledge gleaned from individual case studies to induce coordinated performance improvement projects that affect the community, EMS, and ED. Further case study reviews can reveal other areas in which the HASTe can positively affect change in the continuum of stroke care.
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