No abstract

Introduction: Stroke is a relatively common in hospitalized patients. However, previous studies have shown delays in recognition and initial assessment of in-hospital stroke. We aimed to elucidate that reorganization of in-hospital stroke code protocol can improve process of acute stroke care and save the treatment time. Methods: Our reorganization of in-hospital stroke code comprises the development of in-hospital stroke code protocol and workshop for hospital medical staff. Before the intervention, if the medical staff identified patients with suspected stroke, they first contacted the attending physician, then the physician consulted the stroke neurologists immediately or after imaging. After the intervention, to quickly identify stroke patients, the medical staff can directly consult stroke neurologists when they identified patients with at least one of acute-onset symptoms, including face droop, arm drift, speech disturbance, eye deviation, aphasia, or neglect, within 6-hour from last seen well or stroke recognition. As an educational intervention, we held workshop for nurses and residents with an understanding of how to evaluate stroke symptoms, use the protocol, and manage stroke. Data were compared between 24-month period before and 12-month period after the intervention. Outcome measure included the time from stroke recognition to initial imaging, and evaluation by stroke neurologist, and from initial imaging to groin puncture. Results: One hundred four patients were included (before, 42; after, 62). Significant time savings were seen in the median time from stroke recognition to evaluation by stroke neurologist (91 vs. 56 minutes, p=0.015), and time from initial imaging to groin puncture (113 vs. 68, p=0.040). The rate of consultation to stroke neurologists before initial imaging was significantly increased (21% vs. 47%, p=0.012). The time from stroke recognition (234 vs. 103, p=0.126), and evaluation by stroke neurologist (135 vs. 81, p=0.056) to groin puncture tended to decrease. Conclusion: Reorganization of in-hospital stroke code protocol can improve the time for initial management of in-hospital stroke.