Abstract P816: Nurse-Driven Rapid Covid-19 Testing in Emergency Department Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Stacey Aggabao ◽  
Tawnae Thorsen ◽  
Atul Gupta ◽  
Raeesa Dhanji ◽  
Denise Gaffney ◽  
...  
Keyword(s):  
Emergency Department ◽  
Personal Protective Equipment ◽  
Stroke Care ◽  
Protective Equipment ◽  
Rapid Evaluation ◽  
Ct Scanner ◽  
Stroke Patients ◽  
Specimen Collection ◽  
Normal Code

Introduction: The COVID-19 pandemic presents obstacles to time sensitive emergencies, such as stroke care. In acute strokes, knowing the COVID-19 status may help to preserve personal protective equipment (PPE) in patients in whom a thrombectomy may be indicated and helps to decrease unnecessary exposure. This study aims to demonstrate that rapid evaluation of a patient’s COVID-19 status is feasible without delaying treatment times. Methods: An intradisciplinary team was convened to create a workflow for rapid COVID-19 testing. The Abbott Rapid® COVID-19 swab kit and assay were stocked in the ED Pyxis, utilizing the narcotic count feature to ensure all swabs were accounted. Upon activation of Code Stroke, the ED RN donned PPE and swabbed the patient’s naso-oral pharynx. The collected swab was labeled, placed in a bio-hazard bag, sanitized and handed to a second RN outside of the room. The specimen was taken to a pre-alerted lab technician who prepped the assay after hearing the code stroke. After specimen collection, the patient followed the normal code stroke pathway and was taken to the CT scanner. Metrics were analyzed for the pre COVID-19 (January through April) and during active COVID-19 (May through July) periods. Results: There were 136 code strokes from January thru July 2020. 81 were during pre-COVID vs. 55 during active-COVID. 47 of 55 (96%) were swabbed, 2 (4%) of whom were positive. There was no difference between pre-COVID and active-COVID door to CT initiated time (16 mins [IQR 13-24] vs. 22 mins [IQR 13-25] p=0.75), door to CT resulted time (21 mins [IQR 15-26]) vs. 23 mins [IQR 16-29] p=0.63). 18 patients received tPA pre-COVID and 5 during active-COVID with no difference in DTN (pre: 37.5 mins [IQR 30-43] vs. active: 28 mins {IQR 26-41] p=0.37). Door to CT initiated was faster for those who had their COVID swab performed pre-CT (14 mins [IQR 11.5-16.5] p=0.034) vs. post-CT (20 mins [IQR 17-28]). Likewise, door to CT resulted was also faster pre-CT: 24 mins [IQR 19-32] vs. post-CT: 17 mins [IQR 15-23] (p=0.04). Conclusion: The COVID-19 rapid swab code stroke process was feasible and did not delay treatment times.

Abstract WP280: Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gregg C Fonarow ◽  
Eric E Smith ◽  
Xin Zhao ◽  
Eric D Peterson ◽  
Ying Xian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Ct Scanner ◽  
Critical Pathways ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are utilizing these strategies has not been well studied. Methods: We surveyed 304 hospitals joining Target: Stroke regarding their baseline use of strategies to reduce door-to-needle times in the 1/2008-2/2010 timeframe (prior to the initiation of Target: Stroke). The survey was developed based on literature review and expert consensus for strategies identified as being associated with shorter DTN times and further refined after pilot testing. Categorical responses are reported as frequencies. Results: Hospitals participating in the survey were 50% academic, median 163 (IQR 106-247) ischemic stroke admissions per year, median 10 (IQR 6-17) tPA treated patients per year, and had median 79 minute (IQR 71-89) DTN times. By survey, 214 of 304 hospitals (70%) reported initiating or revising strategies to reduce DTN times in the prior 2 years. Reported use of the different strategies varied in frequency, with use of ischemic stroke critical pathways, CT scanner located in the Emergency Department, and tPA being stored in the Emergency Department being the strategies least frequently employed (Table). As part of Target: Stroke participation, 279 of 304 hospitals (91.5%) indicated they planned to have a dedicated team focused on reducing DTN times. Conclusions: While most US hospitals participating in this survey report use of the strategies to improve the timeliness of tPA administration for acute ischemic stroke, significant variation exists. Further research is needed to understand which of these strategies are most effective in improving acute ischemic stroke care.

Abstract W P269: Collaboration in the Emergency Department Improves Stroke Care

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Julie M Fussner ◽  
Kiefah Awadallah
Keyword(s):  
Emergency Department ◽  
Stroke Patient ◽  
Stroke Care ◽  
Ct Scanner ◽  
Patient Room ◽  
University Hospitals ◽  
Charge Nurse ◽  
Prioritization Process ◽  
Hand Off ◽  
Telephone Calls

Introduction: The purpose of this project is to improve the timeliness of stroke care at University Hospitals Comprehensive Stroke and Cerebrovascular Center (UHCSCC). Several projects were implemented in the Emergency Department (ED): Brain Attack (BAT) Lab Turnaround, ED Medic Role Revision, Standardized Handoff Tool and Dedicated Stroke Patient Room. Methods: First, the BAT lab project addressed the need to expedite lab results since there was no prioritization of specimens. Working with a multidisciplinary team including the ED Lab Quality committee, a new process was developed for the BAT labs using a colored requisition. Second, the ED Medic role was identified to assist with communication of incoming transfers At UHCSCC communication of all patients arriving by EMS or transfers from other facilities is directed through the UH Transfer Center. With an average of 150 patients arriving per day, this requires 8.1 hours of telephone calls placed to the ED charge nurse a month. Third, documentation of the handoff from transporting personnel was written inconsistently in multiple locations. A standardized hand off form was implemented for the nurse to obtain consistent and readily available information to provide efficient care for the stroke patient. Finally, when a new ED was built in 2011, a dedicated stroke room was designed with an attaching CT scanner to further improve the time of diagnosis for the stroke patient. Results: With the new prioritization process for lab specimens, the turnaround times dramatically improved. Average result times decreased by 23 minutes for CBC, 47 minutes for BMP and 35 minutes for PT/ INR. The Medic role revision decreased the telephone calls placed to the ED charge nurse by 5.5 hours a month to allow more time spent assisting with patient care. Handoff documentation improved from 33% to 90% compliance. Finally, in the new ED with the stroke room attached to the CT scanner, the average time from arrival to CT completion decreased from average of 32 to 20 minutes. Conclusions: The implementation of the BAT Lab Turnaround, ED Medic Role Revision, Standardized Handoff Tool and Dedicated Stroke Patient Room projects have all demonstrated that collaboration between the ED and other disciplines has improved the stroke care provided.

scholarly journals Protected Code Stroke

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1891-1895 ◽  
Author(s):  
Houman Khosravani ◽  
Phavalan Rajendram ◽  
Lowyl Notario ◽  
Martin G. Chapman ◽  
Bijoy K. Menon
Keyword(s):  
Resource Management ◽  
Personal Protective Equipment ◽  
Human Performance ◽  
Clinical Status ◽  
Stroke Care ◽  
Infection Prevention And Control ◽  
Protective Equipment ◽  
Healthcare Team ◽  
Crisis Resource Management ◽  
Screening Criteria

Background and Purpose— Hyperacute assessment and management of patients with stroke, termed code stroke, is a time-sensitive and high-stakes clinical scenario. In the context of the current coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus, the ability to deliver timely and efficacious care must be balanced with the risk of infectious exposure to the clinical team. Furthermore, rapid and effective stroke care remains paramount to achieve maximal functional recovery for those needing admission and to triage care appropriately for those who may be presenting with neurological symptoms but have an alternative diagnosis. Methods— Available resources, COVID-19-specific infection prevention and control recommendations, and expert consensus were used to identify clinical screening criteria for patients and provide the required nuanced considerations for the healthcare team, thereby modifying the conventional code stroke processes to achieve a protected designation. Results— A protected code stroke algorithm was developed. Features specific to prenotification and clinical status of the patient were used to define precode screening. These include primary infectious symptoms, clinical, and examination features. A focused framework was then developed with regard to a protected code stroke. We outline the specifics of personal protective equipment use and considerations thereof including aspects of crisis resource management impacting team role designation and human performance factors during a protected code stroke. Conclusions— We introduce the concept of a protected code stroke during a pandemic, as in the case of COVID-19, and provide a framework for key considerations including screening, personal protective equipment, and crisis resource management. These considerations and suggested algorithms can be utilized and adapted for local practice.

Emergency department staff can effectively resuscitate in level C personal protective equipment

2007 ◽  
Vol 19 (2) ◽  
pp. 113-121 ◽  
Author(s):  
Ruwangi Udayasiri ◽  
Jonathan Knott ◽  
David McD Taylor ◽  
Jonathan Papson ◽  
Fiona Leow ◽  
...  
Keyword(s):  
Emergency Department ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Emergency Department Staff ◽  
Department Staff

scholarly journals Association between personal protective equipment and SARS-CoV-2 infection risk in emergency department healthcare workers

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Danique Schmitz ◽  
Marieke Vos ◽  
Renate Stolmeijer ◽  
Heleen Lameijer ◽  
Titus Schönberger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Infection Risk ◽  
Protective Equipment

SARS-COV-2 SEROPREVALENCE AMONG EMERGENCY PROVIDERS AND THE IMPORTANCE OF PERSONAL PROTECTIVE EQUIPMENT.

2021 ◽  
pp. 85-86
Author(s):  
Tuong Pham ◽  
Michael Doctor ◽  
Ryliezl Abby Reyes ◽  
Caroline Runco ◽  
Alberto Hazan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Personal Protective Equipment ◽  
Transmission Rate ◽  
Working Hours ◽  
Protective Equipment ◽  
Surgical Masks ◽  
Exposure Risks ◽  
Testing Site ◽  
Elevated Exposure

Background: Healthcare workers (HCWs) have elevated exposure risks to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there is limited published information regarding the transmission rate and the seroconversion among HCWs. The goals of this study are to determine the seroprevalence among emergency providers and the correlation between working hours and utilization of personal protective equipment with the likelihood of seroconversion. Methods: This prospective study evaluated Emergency Department physicians and advanced practice providers, who had been tested for SARSCoV-2 IgG serology, at 10 different hospitals in the location area. An anonymous survey was sent to the Emergency Department providers via email inquiring about the following: results of serology and/or nasopharyngeal testing, the testing site used, the presence or absence of COVID-19 symptoms, utilization of personal protective equipment (PPEs), exposure to potential COVID-19 patients, and average clinical hours since March. Results: 43 participants responded to the survey. 3 had positive SARS-CoV-2 antibody or viral tests indicating exposures to COVID-19 despite utilization of various types of PPE. There was a surprisingly high number of HCWs treating known/suspected COVID-19 patients without proper PPE (18.6%). 21 (48.8%) HCWs routinely wore an N-95 mask, 11 (25.6%) used a powered air-purifying respirator (PAPR), 6 (14%) wore surgical masks, and 5 (11.6%) used elastomeric face respirators. None of the COVID-19 positive HCWs used a PAPR while treating known or suspected COVID-19 patients. Conclusion: Our knowledge regarding the complications related to SARS-CoV-2 infection post-acute phase remains limited. Our data suggest PAPR use may be protective compared to other PPE modalities. There can be unanticipated long-term morbidities that result from an infection with SARS-CoV-2. Therefore, frontline HCWs, who have an inherently elevated exposure to this virus, must use PPE and maintain vigilance while treating patients, regardless of the presence of COVID-19 symptoms.

Abstract NS8: The Effects of Introducing a Nurse Practitioner Stroke Champion into the Emergency Department

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Lindsay Olson-Mack ◽  
Jacqueline Reardon ◽  
Elton Hedden ◽  
Rowena Carino ◽  
Cynthia VanWyk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Nurse Practitioner ◽  
Treatment Effectiveness ◽  
Stroke Care ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Assessment And Treatment ◽  
Iv Tpa

Background and Purpose: Emergency Department (ED) physicians often manage acute stroke patients without Neurology support at the bedside. Without guidance, they are left to rapidly assess, diagnose and treat acute stroke patients with minimal follow up on treatment effectiveness and patient outcomes. We hypothesized that introducing a Nurse Practitioner (NP) as Stroke Champion into an ED that did not have access to in-house Neurology would drive awareness of acute stroke care, and positively change practice to decrease door to needle times. Methods: The NP started in the 24-bed ED in June 2012. The average daily census of the ED for 2012 was 135 patients per day, and from January to June 2012, ED physicians initiated 46 stroke codes. Although Neurologists were available via telephone, ED physicians were left to accurately assess and initiate stroke codes, determine eligibility, and order IV tPA. In collaboration with the Stroke Medical Director, the Stroke NP conducted multiple education sessions regarding timing metrics in acute stroke care and door to tPA goals with ED clinicians, radiology, lab and pharmacy departments. Data was shared with stakeholders monthly to drive performance improvement initiatives. Results: Rapid improvements were made in all metrics. Mean time to CT first image improved by 19.3 minutes (37.3 to 18.0 minutes) in 6 months, and to 14.7 minutes in 1 year. CT result mean turn-around-time decreased by 19 minutes (from 54.0 to 29.1 minutes) in the first 6 months, and by 22.6 minutes (from 54.0 to 26.0 minutes) at 12 months. Likewise, laboratory result turn-around-times dramatically decreased by a mean of 15.9 minutes (54.4 to 38.5 minutes) over 6 months, and by a mean of 23 minutes (54.4 to 31.0 minutes) within 12 months. IV tPA treatment rates increased from 5% to 14.4% of all ischemic strokes. Door to IV tPA treatment times decreased by a mean of 33.9 minutes (104.5 to 70.6 minutes) in 6 months, and by 46.8 minutes (from 104.5 to 57.7 minutes) within the year. Conclusions: Introducing an NP into the ED to serve as Stroke Champion can provide added support to improve care of acute stroke patients by expediting assessment and treatment.

scholarly journals Percepção do enfermeiro acerca do uso de equipamentos de proteção individual em hospital paraibano

2017 ◽  
Vol 7 (1) ◽  
pp. 01
Author(s):  
Allan Dillammary Araújo Barbosa ◽  
Allan Martins Ferreira ◽  
Edmara da Nóbrega Xavier Martins ◽  
Anne Milane Formiga Bezerra ◽  
Juliana de Almeida Leandro Bezerra
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Work Environment ◽  
Personal Protective Equipment ◽  
Regional Hospital ◽  
Protective Equipment ◽  
Personal Protection ◽  
Work Activities

<p>Biossegurança ou segurança biológica é um conjunto de ações voltadas à prevenção e proteção do trabalhador. Uma estratégia utilizada como forma de evitar contaminação no ambiente de trabalho se dar a partir do uso de Equipamentos de Proteção Individual (EPIs). Objetivou-se analisar a percepção do enfermeiro sobre o uso e importância do EPI diante da assistência aos pacientes. O trabalho trata-se de um estudo do tipo exploratório-descritivo, com abordagem quantiqualitativa, foi realizado com enfermeiros plantonistas do setor de urgência e emergência de um Hospital Regional paraibano. Conforme os dados observa-se que a maioria dos enfermeiros é do gênero feminino, com faixa etária entre 20 e 30 anos de idade, são especialistas e atuam há dois anos no serviço de emergência. Todos os enfermeiros mostraram conhecimento sobre a importância do uso do EPI, relatando as principais doenças que podem acometê-los caso ocorram episódios de contaminação durante a execução das suas atividades laborais. Alguns dos profissionais afirmaram já se contaminar, sendo o material perfurocortante o que mais causou acidentes. Afirmaram que a instituição oferece a maioria dos EPIs necessários para proteção individual, porém só em algumas circunstâncias fazem uso desses equipamentos. Portanto, pôde-se concluir que tais contaminações poderiam ser evitadas se todos os profissionais fizerem uso dos EPIs em todas as situações que envolvam riscos, pondo em prática o conhecimento relatado, conferindo proteção não só ao profissional como a clientela que procura o serviço.</p><p><strong><em>Nurses perception about the use of personal protective equipment in a hospital in parabian</em></strong></p><p>Abstract: Biosafety or security biological is a set of actions aimed at the prevention and protection of the worker. One strategy used in order to avoid contamination in the work environment it's given from the use of Personal Protective Equipment (PPE). The work it is a study of exploratory-descriptive, with a quantiqualitative approach, was conducted with nurses in the sector of urgency and emergency in a Regional Hospital Paraiba, aiming analysis on the use and importance of PPE when providing patient care.  According to data was realized that most nurses are female, aged between 20 and 30 years old, are experts and acting for two years in the emergency department. All nurses showed knowledge about the importance of using PPE, reporting major diseases that can affect them in case occur contamination episodes during the execution of their work activities. Some professionals said they already been contaminated, being the material pierce cutter which caused more accidents. They stated that the institution offers the majority of PPEs required for personal protection, but only in some circumstances they make use of such equipment. Therefore, it was concluded that such contamination could be avoided if all professionals make use of PPE in all situations involving risk, putting into practice the knowledge reported, providing protection not only to the professional as customers seeking service.</p>

Abstract T P261: Non-Contrast Head CT Prior to Comprehensive Neurological Evaluation Reduces Door to Needle Times for Administration of Intravenous rtPA

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Lesia Mooney ◽  
Suzanne Shaw ◽  
Kevin Barrett ◽  
Carol Raper
Keyword(s):  
Emergency Department ◽  
Ct Scanning ◽  
Ct Scanner ◽  
Clinical Workflow ◽  
Stroke Patients ◽  
Head Ct ◽  
Emergency Department Arrival ◽  
Neurological Evaluation ◽  
Exam Room ◽  
Suspected Stroke

Background: American Heart Association/American Stroke Association recommends treatment of eligible acute ischemic stroke patients with intravenous rtPA <60 minutes from emergency department arrival. Purpose: A quality improvement project was designed to reduce the door to needle times for intravenous rtPA administration at Mayo Clinic Florida. We hypothesized that workflow changes in emergency department evaluation of suspected stroke patients would decrease door to needle times. The goal was to treat >75% of patients eligible for IV t-PA within 60 minutes of ED arrival. Methods: We utilized LEAN methods to develop a project charter, identify stakeholders, and visually map the emergency department clinical workflow. Prior to project initiation, suspected stroke patients were taken upon arrival to an exam room for clinical evaluation followed by transport to the CT scanner and return to the exam room for decision-making and rtPA administration. The clinical workflow was changed to obtain patient weight immediately upon arrival, abbreviated patient assessment and lab draws outside of the CT scanner in a holding bay and performing CT scanning prior to transport to an examination room for decision making and rtPA administration. Results: In a 12 month period preceding project initiation, 29 patients were treated with rtPA, 55 % were treated <60 minutes of emergency department arrival. In the 11 month period following implementation of CT scanning prior to neurological evaluation, 57 patients were treated with rtPA, 80 % were treated in <60 minutes of emergency department arrival. The mean door to needle time was reduced from 66 minutes to 46 minutes following the clinical workflow change. No patients experienced clinical deterioration at the time of CT scanning. Conclusions: Non-contrast head CT scan be safely performed prior to comprehensive neurological evaluation and reduces door-to-needle times for intravenous rtPA administration in eligible stroke patients. Validated process improvement paradigms such as LEAN have the potential to reduce door to needle times and improve patient outcomes.

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