Perceptions of the Feasibility and Benefit of Emergent Hyperglycemia Correction Concurrent with Stroke Reperfusion Treatment

Background: Hyperglycemia is common in acute ischemic stroke and is associated with worse outcomes and higher rates of symptomatic intracerebral hemorrhage following reperfusion therapy. Current stroke protocols prioritize time-sensitive reperfusion treatments, often overlooking hyperglycemia management during the emergent phase of care. Objective: This qualitative study explores emergency department registered nurses (EDRNs) and stroke coordinators' knowledge, perceptions, and barriers regarding hyperglycemia management in acute stroke patients undergoing reperfusion therapy. Methods: A phenomenological approach was used to conduct focus groups with 19 participants from 9 primary, 3 thrombectomy-capable, and 7 comprehensive stroke centers across six U.S. states. Thematic analysis identified key patterns related to hyperglycemia management and emergent stroke care. Results: Participants (n=19) identified several barriers to the emergent management of hyperglycemia in stroke patients, including staffing shortages, time constraints, and the absence of specific protocols. Despite the known impact of hyperglycemia on stroke outcomes, it was generally deprioritized in favor of achieving timely reperfusion treatment. The majority of participants reported that hyperglycemia management was not considered a priority in their institutions, particularly in the acute phase of stroke care. Suggestions to improve management included incorporating hyperglycemia treatment into order sets, improving staff education on its importance, and enhancing resource availability to support concurrent management alongside reperfusion therapies. Conclusion: EDRNs and stroke coordinators recognize the importance of glucose measurement but lack focus on hyperglycemia management due to systemic barriers and time-sensitive treatment priorities. Incorporating hyperglycemia management into acute stroke protocols could improve post-reperfusion outcomes and warrants further investigation.