Abstract TP372: BRAIN ALERT: An Emergency Department Initiative to Improve Time Metrics for Patients that Walk in with Stroke Symptoms

Abstract

Introduction: Patients with minor stroke symptoms tend not to call 911. They often come to the Emergency Department (ED) via personal transport, and walk in through the triage area. These patients historically have longer door to needle times. We established the Brain Alert (BA) nurse driven initiative with ED education on an algorithm applicable to patients who walk in with stroke symptoms. This study assesses the difference between time metrics before and after implementation. Methods: BA metrics were based on the TARGET:STROKE guidelines. The intervention was an ED wide education of all ED staff on F.A.S.T symptoms and the BA process. The ED triage nurse was empowered to page a BA and rapidly initiate the bedding of the patient. The BA page triggered the stroke team to rapidly come to the ED and examine the patient simultaneously with the ED physician. Data were recorded for 6 months pre and post implementation. Outcomes included door to initial MD evaluation, stroke team notification, CT scan initiation and interpretation and thrombolytic administration (DTN). Fisher’s Exact and Wilcoxon Rank Sum Tests were used for data analysis. Results: There were 38 walk in patients pre intervention vs. 36 post intervention. Thirteen (35.1%) BA activations occurred post intervention. The most common reason for not calling a BA was the patient did not have F.A.S.T symptoms. No differences in baseline demographics were found. CT scans were ordered and completed quicker post intervention (median ordered: 13.5 [IQR 7-18.5] mins post vs. 17.5 [IQR 12.5-22.5] mins pre, p=0.021), (median completed: 22.5 [IQR 18-27] mins post vs. 25 [IQR 20-30] mins pre, p= 0.024). A higher percentage of patients received thrombolytics ≤60 mins post intervention (84.6% vs. 78.7%), but was not statistically significant, p=0.41). Conclusion: The BA process improved door to CT order and completion times. There was higher percentage of patients who received IVtPA ≤ 60 minutes, which did not reach statistical significance likely due to the small number of patients involved in the study. Institution of a specific algorithm to address patients who walk in with stroke symptoms into a hospital triage area, can result in improved code stroke time metrics.