Abstract WP022: Early Neurology Engagement and Standardized Workflows Improve Inpatient Stroke Treatment Times

Background and Purpose: Comorbidities and inefficient hospital workflows delayed timely treatment of hyperacute stroke in hospitalized patients. The existing Inpatient Stroke Alert evaluation was a linear process, with the neurology consult occurring after completion of the initial work-up. Nurses could activate a Stroke Alert, but neurology engagement was at the discretion of the primary physician and not outlined in standard work. These barriers resulted in treatment delays. The purpose of the quality initiative was to reduce treatment times for in-hospital stroke patients by standardizing early communication with neurology and delineating responsibilities within the response team. Methods: A multidisciplinary workgroup convened to review the literature, identify best practices for evaluation of in-hospital stroke patients, and implement changes to the Inpatient Stroke Alert process using PDSA methodology. The workgroup implemented the following improvements to the workflow: 1) The Rapid Response Team nurse contacts the neurologist upon initiating the Stroke Alert and communicates stroke deficits, Last Known Well, and contact information for the primary provider; 2) Responsibilities for each medical discipline were defined in the algorithm; and 3) The CT scanner was deemed the location for full team assembly. Data on inpatient stroke treatment was analyzed for the 6 months before and after implementation. Results: In the 6 months post-implementation, the median time from stroke alert activation to thrombolytics decreased by 46.8% to 42 minutes (n=4), and the median time to arterial puncture decreased by 22.9% to 90 minutes (n=9). Conclusion: Transforming the culture and workflow to empower nurses to immediately contact neurology streamlined early multidisciplinary communication and collaboration. This, in combination with clearly defined responsibilities for each team member, mitigated unnecessary delays and facilitated a shared treatment decision earlier in the process. In conclusion, nurse-driven multidisciplinary engagement upon stroke activation and standardizing roles resulted in reduced time to stroke treatment.