Abstract W P362: Stroke Coordinators: Surveys from the ASA Southwest Affiliate

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Christy L Casper ◽  
Alexandra Graves ◽  
Michelle Whaley ◽  
Julie Blakie
Keyword(s):  
Best Practice ◽  
Demographic Data ◽  
Educational Preparation ◽  
Additional Information ◽  
Job Functions ◽  
Primary Stroke Center ◽  
Reporting Structure ◽  
Role Responsibilities ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Stroke coordinators (SC) in Colorado meet monthly to share best practice and collaborate with the ASA and industry representatives. Based on informal observation, we believed that many of the coordinators were new in their roles and desired additional information and education on how to be successful. We teamed with the ASA and hosted two conferences; one for Colorado SCs and a larger conference for ASA Southwest affiliates. Demographic data was collected at both conferences. Methods: For the CO conference, surveys were sent to all SCs in the state. For the ASA conference, only those who attended were given the survey. Results were combined and content included: educational preparation, hospital volumes, certification status, reporting structure, orientation plan, role responsibilities, data expectations, and job satisfaction. Partial responses were included. Results: 94 surveys were returned. 70% were SCs for less than 2 years but 40% worked in their hospital for 1 - 5 years and 38% for >5 years. 32/41 worked at a primary stroke center (PSC) and 6/41 worked at a comprehensive stroke center. The majority (81%) were nurses (36% Diploma, 64% Bachelor’s prepared). 18% were Master’s prepared (NP, CNS, and MS in nursing but not NP or CNS). 43% either had a mentor or a structured orientation plan and exactly the same (43%) made up their orientation. 45% reported to Nursing, 40% to Quality, and few (2%) to Neurology. Respondents liked the ability to be creative and affect change at their hospital but disliked the lack of clarity in their role and the number of job functions they are expected to perform. Conclusion: SCs in the Southwest affiliate are primarily nurses with less than 2 years of experience as a SC who had worked at their hospital for at least 1 year but many for over 5 years. Most hospitals are PSCs. They equally had mentorship and training versus developing their role without much direction. SCs enjoy the ability to be creative and affect change but would like additional clarity and expectations to succeed in their roles.

Effect of “drip-and-ship” and “drip-and-drive” on endovascular treatment of acute ischemic stroke with large vessel occlusion: a single-center retrospective study

2021 ◽  
pp. 028418512110068
Author(s):  
Yu Hang ◽  
Zhen Yu Jia ◽  
Lin Bo Zhao ◽  
Yue Zhou Cao ◽  
Huang Huang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Primary Stroke Center ◽  
Secondary Endpoints ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) were usually transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (drip-and-ship [DS]), while driving the doctor from a CSC to a PSC to perform a procedure is an alternative strategy (drip-and-drive [DD]). Purpose To compare the efficacy and prognosis of the two strategies. Material and Methods From February 2017 to June 2019, 62 patients with LVO received endovascular treatment via the DS and DD models and were retrospectively analyzed from the stroke alliance based on our CSC. Primary endpoint was door-to-reperfusion (DTR) time. Secondary endpoints included puncture-to-recanalization (PTR) time, modified Thrombolysis in Cerebral Infarction (mTICI) rates at the end of the procedure, and modified Rankin Scale (mRS) at 90 days. Results Forty-one patients received the DS strategy and 21 patients received the DD strategy. The DTR time was significantly longer in the DS group compared to the DD group (315.5 ± 83.8 min vs. 248.6 ± 80.0 min; P < 0.05), and PTR time was shorter (77.2 ± 35.9 min vs. 113.7 ± 69.7 min; P = 0.033) compared with the DD group. Successful recanalization (mTICI 2b/3) was achieved in 89% (36/41) of patients in the DS group and 86% (18/21) in the DD group ( P = 1.000). Favorable functional outcomes (mRS 0–2) were observed in 49% (20/41) of patients in the DS group and 71% (15/21) in the DD group at 90 days ( P = 0.089). Conclusion Compared with the DS strategy, the DD strategy showed more effective and a trend of better clinical outcomes for AIS patients with LVO.

How do treatment times impact on functional outcome in stroke patients undergoing thrombectomy in Germany? Results from the German Stroke Registry

2021 ◽  
pp. 174749302098526
Author(s):  
Juliane Herm ◽  
Ludwig Schlemm ◽  
Eberhard Siebert ◽  
Georg Bohner ◽  
Anna C Alegiani ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Center Time

Background Functional outcome post-stroke depends on time to recanalization. Effect of in-hospital delay may differ in patients directly admitted to a comprehensive stroke center and patients transferred via a primary stroke center. We analyzed the current door-to-groin time in Germany and explored its effect on functional outcome in a real-world setting. Methods Data were collected in 25 stroke centers in the German Stroke Registry-Endovascular Treatment a prospective, multicenter, observational registry study including stroke patients with large vessel occlusion. Functional outcome was assessed at three months by modified Rankin Scale. Association of door-to-groin time with outcome was calculated using binary logistic regression models. Results Out of 4340 patients, 56% were treated primarily in a comprehensive stroke center and 44% in a primary stroke center and then transferred to a comprehensive stroke center (“drip-and-ship” concept). Median onset-to-arrival at comprehensive stroke center time and door-to-groin time were 103 and 79 min in comprehensive stroke center patients and 225 and 44 min in primary stroke center patients. The odds ratio for poor functional outcome per hour of onset-to-arrival-at comprehensive stroke center time was 1.03 (95%CI 1.01–1.05) in comprehensive stroke center patients and 1.06 (95%CI 1.03–1.09) in primary stroke center patients. The odds ratio for poor functional outcome per hour of door-to-groin time was 1.30 (95%CI 1.16–1.46) in comprehensive stroke center patients and 1.04 (95%CI 0.89–1.21) in primary stroke center patients. Longer door-to-groin time in comprehensive stroke center patients was associated with admission on weekends (odds ratio 1.61; 95%CI 1.37–1.97) and during night time (odds ratio 1.52; 95%CI 1.27–1.82) and use of intravenous thrombolysis (odds ratio 1.28; 95%CI 1.08–1.50). Conclusion Door-to-groin time was especially relevant for outcome of comprehensive stroke center patients, whereas door-to-groin time was much shorter in primary stroke center patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03356392 . Unique identifier NCT03356392

Abstract W P292: A Comparative Analysis of the Requirements for Certification of Stroke Programs, by Type and by Nationally Recognized Certifying Body

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Stacey Lang
Keyword(s):  
Selection Process ◽  
Evaluation Process ◽  
Program Leaders ◽  
Primary Stroke Center ◽  
Similarities And Differences ◽  
Certification Organizations ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Core Measures ◽  
Certification Requirements

Background and Purpose: There are currently three main, nationally recognized organizations that certify facilities as primary or comprehensive stroke centers. One of these organizations also offers a “Stroke Ready” designation. While each of these organizations share many of the same requirements, there are likewise many unique requirements between certifying bodies with respect to the certification requirements, process, performance, and on-going expectations. All should be considered when choosing a partner for certification by organizations that are committed to achieving an appropriate level of certification as determined by clinical capabilities. Differences in core measure requirements and definitions, data collection expectations and re-certification cycles among other factors are often overlooked when stroke program leaders are identifying the best certification partner for their particular organization. This poster will detail the similarities and differences among the various stroke program certifying organizations and present a detailed methodology to assist program leaders with the partner selection process. Methods: The three stroke program certifying organizations were examined for review cycles, levels of certification offered, requirements related to hospital certifications, and reportable core measures. Other factors such as cost, the actual certification process, and other considerations that may impact the successful achievement of certification within a particular organization were also reviewed. Results/Conclusion: While there are many similarities in the stroke center certification requirements and processes among the three certifying organizations, there are also significant differences. In order to ensure that the end product of a journey to certification will align with a hospital’s values, budget, and vision for the stroke program, an evaluation process in advance of certifying body selection is essential. Awareness of the similarities and differences among the stroke certification organizations can facilitate a hospital’s decision-making process for pursuit of certification as a stroke ready center, primary stroke center or comprehensive stroke center

Abstract WP455: Memorial Hermann Hospital System Stroke Coordinators: Working as One

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sandi G Shaw ◽  
Isabel Gonzales ◽  
Hari Indupuru ◽  
Nicole Harrison ◽  
Sean Savitz ◽  
...  
Keyword(s):  
Best Practice ◽  
Quality Care ◽  
High Volume ◽  
Work Load ◽  
Joint Commission ◽  
Large Hospital ◽  
Hospital System ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Joint Commission

Background: Many hospital stroke programs fail to meet or maintain the certification requirements of The Joint Commission (TJC) as a Primary Stroke Center (PSC) or Comprehensive Stroke Center (CSC). The most common reason is the absence of a dedicated stroke program coordinator. There are opportunities for improvement to promote stroke coordinator growth and retention. Purpose: We created The Memorial Hermann Hospital System Stroke Coordinator Alliance to combine resources, reduce workload, and support stroke coordinators in order to promote adherence to best practice and maintain TJC stroke certification. Methods: The Memorial Hermann Hospital System Stroke Coordinator Alliance was developed in 2015. It includes 14 nurses who represent 11 acute care hospitals within a large hospital system in Houston (Figure1). Four of the hospitals are CSCs, five are PSCs, and two are not certified. Monthly meetings are conducted to create standardized access to resources, stroke coordinator orientation, education, medical power plans, process improvement, and data development. Coordinator work groups, a central email and shared drive, biweekly data meetings, and a buddy system were created to reduce work load, improve electronic communication, and streamline data review procedures. A partnership was created to onboard new coordinators and to prepare for mock and real time survey visits. In 2018 data abstraction was standardized across hospitals with use of a homegrown database Stroke Program Registry (REGIS). Results: Of the 14 Stroke Coordinators in place during fiscal years 2015 - 2019, retention was 100%. A total of 19 stroke surveys were completed and recognized as successful by The Joint Commission. A total of 17,148 stroke patients were received with PSC measures averaging greater than 95% and CSC measures above 90%. Conclusion: Implementing program development support for stroke coordinators improves retention and quality care in a high volume stroke system.

Prehospital Comprehensive Stroke Center vs Primary Stroke Center Triage in Patients With Suspected Large Vessel Occlusion Stroke

2021 ◽  
Author(s):  
Tareq Kass-Hout ◽  
Jungwha Lee ◽  
Katie Tataris ◽  
Christopher T. Richards ◽  
Eddie Markul ◽  
...  
Keyword(s):  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center

scholarly journals Target Stroke: Best Practice Strategies Cut Door to Thrombolysis Time to <30 Minutes in a Large Urban Academic Comprehensive Stroke Center

2018 ◽  
Vol 9 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Nirav Bhatt ◽  
Erika T. Marulanda-Londoño ◽  
Kunakorn Atchaneeyasakul ◽  
Amer M. Malik ◽  
Negar Asdaghi ◽  
...  
Keyword(s):  
Best Practice ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Field triage for endovascular stroke therapy: a population-based comparison

2019 ◽  
Vol 12 (3) ◽  
pp. 233-239 ◽  
Author(s):  
Mahesh V Jayaraman ◽  
Morgan L Hemendinger ◽  
Grayson L Baird ◽  
Shadi Yaghi ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Population Based ◽  
Stroke Severity ◽  
Matched Pairs ◽  
Inclusion Criteria ◽  
Stroke Therapy ◽  
Transport Time ◽  
Field Triage ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center

BackgroundEndovascular therapy (EVT) for stroke improves outcomes but is time sensitive.ObjectiveTo compare times to treatment and outcomes between patients taken to the closest primary stroke center (PSC) with those triaged in the field to a more distant comprehensive stroke center (CSC).MethodsDuring the study, a portion of our region allowed field triage of patients who met severity criteria to a more distant CSC than the closest PSC. The remaining patients were transported to the closest PSC. We compared times to treatment and clinical outcomes between those two groups. Additionally, we performed a matched-pairs analysis of patients from both groups on stroke severity and distance to CSC.ResultsOver 2 years, 232 patients met inclusion criteria and were closest from the field to a PSC; 144 were taken to the closest PSC and 88 to the more distant CSC. The median additional transport time to the CSC was 7 min. Times from scene departure to alteplase and arterial puncture were faster in the direct group (50 vs 62 min; 93 vs 152 min; p<0.001 for both). Among patients who were independent before the stroke, the OR for less disability in the direct group was 1.47 (95% CI 1.13 to 1.93, p=0.003), and 2.06 (95% CI 1.10 to 3.89, p=0.01) for the matched pairs.ConclusionsIn a densely populated setting, for patients with stroke who are EVT candidates and closest to a PSC from the field, triage to a slightly more distant CSC is associated with faster time to EVT, no delay to alteplase, and less disability at 90 days.

Abstract MP35: Blood Pressure Reductions Before Arrival at a Thrombectomy-Capable Hospital Are Associated With Neurologic Worsening in Patients With Large-Vessel Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jessica Kobsa ◽  
Ayush Prasad ◽  
Alexandria Soto ◽  
Sreeja Kodali ◽  
Cindy Khanh Nguyen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Management Strategies ◽  
Vessel Occlusion ◽  
Time Points ◽  
Good Outcome ◽  
Primary Stroke Center ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Radiographic Data

Introduction: Decreases in blood pressure (BP) during thrombectomy are associated with infarct progression and worse outcomes. Many patients present first to a primary stroke center (PSC) and are later transferred to a comprehensive stroke center (CSC) to undergo thrombectomy. During this period, important BP variations might occur. We evaluated the association of BP reductions with neurological worsening and functional outcomes. Methods: We prospectively collected hemodynamic, clinical, and radiographic data on consecutive patients with LVO ischemic stroke who were transferred from a PSC for possible thrombectomy between 2018 and 2020. We assessed systolic BP (SBP) and mean arterial pressure (MAP) at five time points: earliest recorded, average pre-PSC, PSC admission, average PSC, and CSC admission. We measured neurologic worsening as a change in NIHSS (ΔNIHSS) from PSC to CSC >3 and functional outcome using the modified Rankin Scale (mRS) at discharge and 90 days. Relationships between variables of interest were evaluated using linear regression. Results: Of 91 patients (mean age 70±16 years, mean NIHSS 12) included, 13 (14%) experienced early neurologic deterioration (ΔNIHSS>3), and 34 (37%) achieved a good outcome at discharge (mRS<3). We found that patients with good outcome had significantly lower SBP at all five assessed time points compared to patients with poor outcome (Figure 1, p<0.05). Percent change in MAP from initial presentation to CSC arrival was independently associated with ΔNIHSS after adjusting for age, sex, and transfer time (p=0.03, β=0.27). Conclusions: Patients with poor outcomes have higher BP throughout the pre-CSC period, possibly reflecting an augmented hypertensive response. Reductions in SBP and MAP before arrival at the CSC are associated with neurologic worsening. These results suggest that BP management strategies in the pre-CSC period to avoid large reductions in BP may improve outcomes in patients affected by LVO stroke.

Abstract WP340: Impact of Increasing Primary Stroke Center Transfers on Comprehensive Stroke Center Capacity

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jane Holl ◽  
Andy Cai ◽  
Lauren Ha ◽  
Alin Hulli ◽  
Melina Paan ◽  
...  
Keyword(s):  
Systems Of Care ◽  
Vessel Occlusion ◽  
Capacity Limits ◽  
Transfer Rates ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Systems Of Care ◽  
Stroke Center ◽  
Occupancy Rates ◽  
Bed Occupancy Rates

Introduction: Given the time-sensitive benefits of acute stroke (AS) treatments, stroke systems of care must balance reducing door-in-door-out (DIDO) time at primary stroke centers (PSCs) with capacity limits at comprehensive stroke centers (CSCs). For example transferring more AS patients earlier in the process (e.g., prior vascular imaging for large vessel occlusion) from PSCs would result in more inappropriate transfers to CSCs that could overburden these centers.We conducted a simulation to estimate the balance between increased AS transfers from PSCs to CSCs and the percent of CSC time on “bypass” (inability to accept transfers to neuro-ICU). Methods: Clinicians from 3 Chicago-area CSCs and 3 affiliated PSCs and the Chicago Emergency Medical Services (EMS) created a PSC DIDO process map. We assumed CSC time on bypass is affected by AS and non-AS admissions from the CSC and from the affiliated PSCs. Input data were obtained fromtheChicago region registry (e.g., # PSC to CSC transfers), peer reviewed literature (US average transfer rate of AS patients to CSCs), EMS (PSC-CSC affiliations), and CSCs (e.g., average bed occupancy rates). CSC size was estimated by #neuro-ICU beds: small (12 beds), medium (23 beds), and large (28 beds). The simulation output was % time of CSC on “bypass”. Results: Table shows % time of CSC on bypass by varying PSC AS transfer rates for each category of CSC size. Larger increases in PSC transfer rates resulted in modest increases in CSC bypass rates, particularly for medium and large CSCs. Validation with data from one CSC showed < 4% overestimate of CSC % time on bypass. Conclusion: CSCs with more beds have efficiencies of scale leading to lower % time on bypass, even with increases in PSC AS transfer rates proportionate to CSC size. This model allows stroke systems of care to compute regional CSCs’ % time on bypass based on actual PSCs’ transfer rates and CSC size.

Abstract WP373: Emergency Medical Service Stroke Education in a Rural Community: Need for Improvement

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pauline M Rankin ◽  
Dianne Marsh ◽  
James McLaughlin
Keyword(s):  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Signs And Symptoms ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Primary Stroke Center ◽  
Stroke Education ◽  
Comprehensive Stroke Center ◽  
Stroke Center

According to The Journal of Emergency Medical Services (EMS) the goal of stroke care is to minimize brain injury and maximize recovery. The stroke chain of survival links actions taken by patients, family, EMS and healthcare providers. Recent innovations in stroke treatment require accurate identification and appropriate triage to the appropriate treatment facility. Evidence in the literature demonstrates variability with EMS correct identification of stroke patients between 30% and 80%. Our 164 bed primary stroke center in rural Pennsylvania has been active in providing stroke education on an annual basis to emergency medical services within a two county radius. As part of our ongoing process improvement we wanted to evaluate the emergency medical technicians and paramedics knowledge of stroke signs and symptoms, their understanding of the evaluation, treatment and triage of stroke patients. A standard questionnaire with 14 variables was developed using the American Heart and Stroke Association prehospital guidelines. The questionnaire included 16 stroke and non stroke symptoms, identifying transport to primary verses comprehensive stroke centers and initial evaluation. A sample population of 90 emergency medical service staff were asked to complete the questionnaire with 28 (31%) responses received. All participants indicated they were confident to recognize stroke signs and symptoms but 6 of the non stroke items were chosen as stroke symptoms. All participants indicated they were confident in the initial evaluation of a stroke patient but 14 (50%) appropriately identified airway, breathing, circulation as the first evaluation. Evaluating triage knowledge, 26 (93%) stated confidence in decision to transport to a primary stroke center and 22 (79%) to a comprehensive stroke center, however, appropriate decision to transport to a primary stroke center was identified correctly by 46% a comprehensive stroke center 66%. In conclusion, results from this study suggest that in this rural setting, barriers exist in prehospital recognition and evaluation of the stroke patient for which proper education may be remediable. Our goal is to use this information to revise our current EMS stroke education program and enhance prehospital assessment and triage.

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