No abstract

No abstract

Background: Rapid assessment of patients that present to the emergency center with acute stroke symptoms is crucial to the timely administration of intravenous thrombolysis. The “golden hour” is recognized by the American Heart Association as the standard of care for treatment of acute ischemic stroke [1]. Door to treatment in ≤ 60 minutes can be difficult to achieve, and in 2010 < 30% of hospitals participating in GWTG attained this goal [2]. One step that can be particularly challenging during the expedited stroke assessment is door to head CT interpretation time in ≤ 45 minutes. We sought to determine factors that delay head CT turnaround times > 45 minutes. Methods: A retrospective stroke database review was completed on 165 patients presenting to the emergency center with acute stroke symptoms in the 0-4.5 hour time window from January 2014 to May 2015. Inclusion criteria was age 18-95 years with an initial NIHSS of 1-42, and a head CT completed at our hospital. Inpatients that developed acute stroke symptoms were excluded from the study. Patients were further stratified by NIHSS and age. Results: The mean age was 75 years and 50% were female. The average head CT turnaround time was 38.1 minutes and the average NIHSS was 8.11. Fifty three patients (32.1%) received acute reperfusion therapy. The average head CT turnaround time for a NIHSS of 1-3 was 47.4 minutes; NIHSS of 4-9 was 38.4 minutes; NIHSS of 10-24 was 25.2 minutes; NIHSS ≥ 25 was 34.5 minutes. There was no significant difference in the head CT turnaround time based on age. Conclusion: Patients presenting to the emergency center with a NIHSS of 1-3 had delayed head CT turnaround times compared to patients presenting with more severe stroke symptoms, and furthermore, did not meet the goal head CT interpretation time of ≤ 45 minutes. One possible reason for this finding is that patients with minor stroke symptoms are less likely to receive intravenous thrombolysis. However, expanding literature suggests that nearly 30% of patients with lower NIHSS scores at discharge have significant disability at 90 days [3]. Multiple educational interventions will be implemented in the emergency center to improve head CT turnaround times in patients with low NIHSS scores on presentation.

Background: Stroke is a leading cause of hospital admissions among the elderly, and reducing readmission rates has become a primary goal of healthcare reform. Hospitals are now being held financially responsible for 30 day readmission rates exceeding their expected rate [1]. Our aim was to determine if patients seen in the comprehensive stroke discharge clinic had reduced 30 day readmissions compared to standard hospital follow up after ischemic stroke. Methods: Patients with a discharge diagnosis of ischemic stroke receive a phone call from the neurology office staff within 3 business days of hospital discharge to schedule an appointment with a mid-level provider in the comprehensive stroke discharge clinic within 1-3 weeks. Eligibility for the clinic includes patients ≥ 18 years of age that are either discharged to home directly or discharged to home from inpatient rehabilitation. We performed a retrospective stroke database search of patients meeting this criteria from May 2015 to June 2016. Patients were excluded from the search if they had an inpatient stroke event. Results: Of the 526 patients reviewed, 116 patients (22.1%) were seen in the comprehensive stroke discharge clinic. The average age of patients seen in clinic was 67 years and the average age of patients in the non-clinic group was 69 years. Approximately 12% of patients in each group received acute reperfusion therapy. There was only one 30 day related readmission in the clinic group, and fourteen 30 day related readmissions in the non-clinic group (0.86% versus 3.41%; 95% CI 0.12-4.99%). There were eight 30 day all cause readmissions in the clinic group, and forty-two 30 day all cause readmissions in the non-clinic group (6.90% versus 10.24%; 95% CI -2.12-8.81%). Conclusion: The comprehensive stroke clinic model may reduce 30 day related readmissions for patients discharged to home. However, there were limitations to this study. The percentage of patients seen in the comprehensive stroke clinic was low. The goal is to improve the clinic follow up rate over the course of the next year. In addition, patients were excluded from the clinic if they were discharged to a skilled nursing facility, which is often associated with a higher readmission rate.