Abstract P849: Effects of Standardized Stroke Protocols on Nursing Confidence and Knowledge in Low Volume Telestroke Emergency Departments

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michelle Provencher ◽  
Stephen A Figueroa ◽  
Robin Novakovic ◽  
Linda Hynan ◽  
Daiwai M Olson ◽  
...  
Keyword(s):  
Nursing Education ◽  
Acute Stroke ◽  
Emergency Departments ◽  
Intervention Group ◽  
Stroke Care ◽  
Controlled Study ◽  
Workflow Model ◽  
Acute Stroke Care ◽  
Post Intervention ◽  
Care Protocol

Introduction: Nurses and staff in Emergency Departments (ED) with low monthly case volumes have few opportunities to build confidence and solidify skills in acute stroke management. The Nursing-driven Acute Stroke Care (NAS-Care) study tested a workflow model with empowerment of ED bedside nurses, clear role assignments for team members, and standardized protocols including a predefined run sheet. Methods: Seven Texas hospitals participated in this prospective, multisite, baseline-controlled study as part of the Lone Star Stroke Research Consortium. After three months of blinded baseline data collection, the following interventions were implemented: NIHSS certification, nursing education including mock stroke codes, and a standardized flowsheet for code organization and documentation (run sheet). Participating nurses were surveyed before and after implementation of this process. Results: The study was completed at 6 hospitals, with 180 patients in the pre-intervention group and 267 in the post-intervention group. The study intervention was found to improve Door-to-ED provider and Door-to-CT metrics but not physician-dependent metrics, Door-to-Needle or Door-to-Provider times (Provencher et al, ISC 2020). Completed surveys were returned by 97 nurses (pre-intervention) and 57 nurses (post-intervention). There were significant increases in the following questions (10 point scale, p<.001): “I understand goals and processes of stroke code activation”, “stroke codes at my institution are completed efficiently”, and “stroke codes are nursing-driven.” In the post-intervention surveys, nurses reported that the NAS-Care protocol improved understanding (mean score 8.0 +/- 2.4 SD/10) and efficiency (8.2 +/- 2.4/10), and reported that they would recommend NAS-Care to be adopted at other institutions (8.8 +/- 2.1/10). Conclusion: Standardized nurse-driven stroke protocols improved self-assessed knowledge and confidence for nurses in EDs utilizing telestroke, in addition to gains in staff-dependent stroke metrics.

Abstract TMP65: The Effects of Standardized Nursing Protocols on Stroke Code Time Metrics - A Multi-Site Telestroke Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michelle Provencher ◽  
Stephen Figueroa ◽  
Robin Novakovic ◽  
Linda Hynan ◽  
Farhaan Vahidy ◽  
...  
Keyword(s):  
Nursing Education ◽  
Emergency Departments ◽  
Interim Analysis ◽  
Heart Association ◽  
Stroke Care ◽  
Controlled Study ◽  
Control Group ◽  
Acute Stroke Care ◽  
Post Intervention ◽  
Care Study

Introduction: Emergency Departments utilizing telestroke technology are less likely to meet American Heart Association/American Stroke Association’s recommended Door to Needle goal of less than 45 minutes. The Nursing Driven-Acute Stroke Care (NAS-Care) study tested effects of standardized stroke protocols on key workflow best practices. Methods: Seven non-academic stroke hospitals in the Lone Star Stroke Consortium’s network participated in this prospective, multi-site, baseline-controlled study from February 2015 - December 2018. After three months of blinded baseline data collection, the following interventions were implemented: NIHSS certification, nursing education including mock stroke codes, and a standardized flowsheet for code organization and documentation. The NAS-Care Run Sheet was also used to collect six months of post-intervention data. Results: Six hospitals completed the study. Study enrolment was halted after interim analysis of 447 patients, 180 in the pre-intervention control group and 267 in the post-intervention follow-up. The proportion of patients receiving alteplase was 18.9% (control) and 18.4% (intervention, NS). In the interim analysis, Door-to-ED Provider and Door-to-CT times were reduced after intervention while Door-to-Specialists and Door-to-Needle times were not significantly improved (table). Conclusion: Standardized nursing education and protocols improved staff-dependent initial stroke time metrics in Emergency Departments utilizing telestroke. Additional workflows for telestroke physicians may be required to optimize alteplase administration metrics. Final results of the NAS-Care study will be presented at the International Stroke Conference.

Acute stroke care in non-urban emergency departments

Neurology ◽  
2001 ◽  
Vol 57 (11) ◽  
pp. 2006-2012 ◽  
Author(s):  
W.S. Burgin ◽  
L. Staub ◽  
W. Chan ◽  
T.H. Wein ◽  
R.A. Felberg ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Departments ◽  
Stroke Care ◽  
Acute Stroke Care

scholarly journals Nurse-Initiated Acute Stroke Care in Emergency Departments

Stroke ◽  
2019 ◽  
Vol 50 (6) ◽  
pp. 1346-1355 ◽  
Author(s):  
Sandy Middleton ◽  
Simeon Dale ◽  
N. Wah Cheung ◽  
Dominique A. Cadilhac ◽  
Jeremy M. Grimshaw ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Emergency Departments ◽  
Stroke Care ◽  
Acute Stroke Care

Realistic simulation is associated with healthcare professionals’ increased self-perception of confidence in providing acute stroke care: a before-after controlled study

2021 ◽  
Vol 79 (1) ◽  
pp. 2-7
Author(s):  
Suzete Nascimento FARIAS DA GUARDA ◽  
João Pedro Souza SANTOS ◽  
Mariana Sampaio Motta REIS ◽  
Rogério da Hora PASSOS ◽  
Luis Claúdio CORREIA ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Healthcare Professionals ◽  
Stroke Care ◽  
Controlled Study ◽  
Self Perception ◽  
Acute Stroke Care ◽  
Convenience Sample ◽  
Realistic Simulation ◽  
Post Test ◽  
The Impact

ABSTRACT Background: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. Objective: To assess the impact of a stroke realistic simulation course on clinicians’ self-perception of confidence in the management of acute stroke. Methods: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees’ self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. Results: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. Conclusions: This stroke realistic simulation course was associated with an improvement on trainees’ self-perception of confidence in providing acute stroke care.

Abstract P37: A Novel Emergency Stroke Alert System Reduces Door-to-CT And Door-to-Needle Time in Patients With Acute Ischemic Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Muhammad A Pervez ◽  
Joshua N Goldstein ◽  
Natalia S Rost ◽  
Joyce Mclntyre ◽  
Joseph Fay ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Stroke Care ◽  
National Guidelines ◽  
Alert System ◽  
Acute Stroke Care ◽  
Post Intervention ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Increased Risk ◽  
Iv Tpa

Background: National guidelines recommend eligible acute stroke patients undergo neuroimaging within 25 min and IV tPA within 60 min. In order to reduce door-to-needle time, we implemented an “ED2CT” virtual group pager which allows ED staff to simultaneously activate the Stroke Team, neuroradiologists, CT technologists, nursing supervisors and pharmacists. Methods: We performed an IRB approved retrospective review of a prospectively acquired cohort of consecutive patients with ischemic stroke presenting to a single tertiary stroke center using our Get With the Guidelines Stroke (GWTG-S) database. We compared patients who received IV tPA within 3 hours of symptom onset pre- (March 2006-April 2008) to post-intervention (September 2008-December 2009) by Wilcoxon or Fisher's exact as appropriate. Results: Overall, there were 56 patients in the pre-intervention and 53 in the post-intervention groups. Patients were 50.5% male, median age was 76 [IQR 63, 85] years, median time to presentation was 50 [IQR 33, 87] min, and median initial NIHSS was 14 [IQR 8, 20]. None of these variables were significantly different between the pre- and post-intervention groups. Implementation of the ED2CT alert was associated with a reduction of 31% in door-to-CT time (29 [22, 40] vs. 20 [16, 29] min; p=<0.001) and 13.5% in door-to needle time (59 [42, 78] vs. 51 [35, 62] min; p=0.02). In addition, there was an increase of 55% in the proportion of patients undergoing CT within 25 min (42.9% vs.66.7 % p=0.01) and 39% in door-to needle within 60 min (51.8% vs. 72.0% p=0.03). Symptomatic intracerebral hemorrhage (sICH) was infrequent among patients receiving IV tPA with or without rescue IA reperfusion (n=109, 8.3%) and those with IV tPA only (n=83, 6.0%); there was a trend in reduced sICH rate post intervention (11.6% vs. 0%; p=0.06). Conclusions: A novel emergency alert system with which the ED attending directly activates multiple members of the acute stroke clinical and imaging team was associated with an improved door-CT time and improved door-tPA time without an increased risk of sICH. This approach aligns acute stroke care activation with trauma and emergency cardiac care and suggests that team-based approaches may be better than specialty -specific responses.

scholarly journals Cost burden and cost-effective analysis of the nationwide implementation of the Quality in Acute Stroke Care protocol in Australia

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C M Marquina ◽  
Z A Ademi ◽  
E Z Zomer ◽  
R O A Ofori-Asenso ◽  
R T Tate ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Societal Perspective ◽  
Stroke Care ◽  
Decision Analytic Model ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Stroke Incidence ◽  
Care Protocol ◽  
Life Years ◽  
The Cost

Abstract Background The Quality in Acute Stroke Care (QASC) protocol is a multidisciplinary approach to implement evidence-based treatment after acute stroke that reduces death and disability. Aim This study sought to evaluate the cost-effectiveness of implementing the QASC protocol across Australia, from a healthcare and a societal perspective. Methods A decision-analytic model was constructed to reflect one-year outcomes post-stroke, aligned with the stroke severity categories of the modified Rankin scale (mRS). Decision analysis compared outcomes following implementation of the QASC protocol versus no implementation. Population data were extracted from Australian databases and data inputs regarding stroke incidence, costs, and utilities were drawn from published sources. The analysis assumed a progressive uptake and efficacy of the QASC protocol over five years. Health benefits and costs were discounted by 5% annually. The cost of each year lived by an Australian, from a societal perspective, was based on the Australian Government's “value of statistical life year” (AUD 213,000). Results Over five years, the model predicted 263,722 strokes among the Australian population. The implementation of the QASC protocol was predicted to prevent 1,154 deaths and yield a gain of 876 years of life (0.003 per stroke), and 3,180 quality-adjusted life years (QALYs) (0.012 per stroke). There was an estimated net saving of AUD 65.2 million in healthcare costs (AUD 247 per stroke) and AUD 251.7 million in societal costs (AUD 955 per stroke). Conclusions Implementation of the QASC protocol in Australia represents both a dominant (cost-saving) strategy, from a healthcare and a societal perspective. FUNDunding Acknowledgement Type of funding sources: None. Decision tree PSA

Abstract TP250: Reducing Treatment Time in Acute Ischemic Stroke by Utilizing a Kaizen Model

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mohamad Fayad ◽  
Jussie` Lima ◽  
Dawn Beland ◽  
Ilene Staff ◽  
Lincoln Abbott ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Treatment Time ◽  
Stroke Care ◽  
Work Flow ◽  
Workflow Model ◽  
Ct Scanner ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Flow Process ◽  
Improvement Project

Introduction: Treating patients suspect of acute stroke requires efficient multidisciplinary teamwork in order to provide appropriate care. Several “Lean Management” methods have been applied in a variety of healthcare settings. Kaizen, meaning “improvement” in Japanese is a tool which emphasizes empowerment of employees on creating value streams to identify and reduce wastes, synchronize work flow processes, manage variability, and devise communication and sustainability plans. We report on the use of this methodology to improve our acute stroke care metrics. Objective: To optimize the management of the acute stroke patient flow process from the emergency department ED to destination therapy by applying the Kaizen methods. Methodes: This is a quality improvement project designed to evaluate the efficiency of the new workflow model for acute stroke that was put into place June 2018 at Hartford Hospital. A 5 day event spent involving all stakeholders from patient registration to destination treatment (IV or mechanical thrombolytic therapy) were conducted. During this event, a time work flow process for the management of suspected stroke patients was identified and an appropriate plan was formulated to reduce times. The following parameters were utilized: Door to CT scanner time (DTCT), Door to drug (IV-tPA) (DTD), and Door to mechanical thrombectomy puncture time (DTP). We included all stroke patients presenting to the ED and treated at our institution 6 months prior and post implementation. A non-parametric analysis was utilized. Results: A total of 135 patients were included in this analysis, 60 prior and 75 post Kaizen. Improvement across all parameters was observed post Kaizen with an average reduction time of DTCT 5 min, DTD 5min, and DTP 22min. The median times pre-Kaizen were; DCT 14min IQR 6-27, DTD 55min IQR 43.5-77.5, and DTP 128min IQR 88-151. The median times post-Kaizen were; DTCT 9min IQR 6-23, DTD 50.5min IQR 37-64, and DTP 106 min IQR 83.5-141.5. Conclusion: By utilizing the Kaizen, we identified numerous opportunities to reduce variability, standardize workflow processes, and ultimately reduce all parameter times. As time is brain, reducing pretreatment times favorably impacts patients’ outcomes and reduces morbidity in stroke.

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