Abstract P838: Stroke Center Certification of a Community Hospital Results in Six Fold Increase in Thrombolytic Treatment for Stroke

Introduction: Prior studies that have demonstrated improved quality metrics after stroke certification often have added new neurological services to become certified. We aimed to evaluate the changes in volume of acute stroke/TIA and thrombolytic treatments in a hospital that underwent Primary Stroke Certification after seven years of established inpatient neurology and telestroke support. Methods: A retrospective analysis of prospectively collected data was completed from a community hospital. Data included 20 months prior to stroke certification (including 12 months with a stroke coordinator) and 17 months after certification. Annualized thrombolytic treatment and total stroke/TIA admissions were reviewed. Mann Whitney tests were used to determine if thrombolytic treatment, patients identified for mechanical stroke thrombectomy (MST), or both [total acute ischemic stroke (AIS) treatment] and total stroke/TIA volume per month differed before and after stroke certification. A subgroup analysis used a Mann Whitney to determine if the addition of a stroke coordinator during preparation for certification affected outcome metrics. Results: The hospital admitted 677 stroke/TIA patients during the study period, 230 before (82 without a stroke coordinator, 148 with a stroke coordinator) and 447 after stroke certification. Thrombolytic treatment increased from 2.4 patients per year prior to certification and 14.8 patients per year after stroke certification. The following outcome variables were increased after certification: thrombolytic treatments (1 vs. 0, p<0.001), patients identified for MST (1 vs. 0, p=0.001), total AIS treatments (1 vs. 0, p<0.001) and total stroke/TIA volume (27 vs. 11, p<0.001). Subgroup analysis suggested that preparation with a stroke coordinator was associated with increases in total AIS treatments (p=0.04) and telestroke requests (p=0.04); however, no differences in total stroke/TIA volume (p=0.18), thrombolytic treatments (p=0.08) or MST (p=0.41) were appreciated in absence of stroke coordinator. Conclusions: We found significantly increased rates of thrombolytic treatments, total stroke/TIA volume and patients identified for MST in a community hospital after primary stroke certification.