Abstract
Introduction
An updated stroke process was designed and implemented at an Acute Stroke Ready community
hospital that relies on telestroke services. The objectives of the current quality
improvement project were to describe the updates to the stroke process and compare
pre- and postintervention data on nurse-driven elements of the process, namely telestroke
notification and neurologist assessment.
Methods
Our multidisciplinary team reviewed quality data over several months to identify areas
of improvement in the stroke process. Delays in door to telestroke notification and
neurologist assessment were identified. A new process was developed and implemented,
including e-alert notification and storing the telestroke cart in the computed tomography
suite. The study period was 14 months, with nonrandomized, convenience sample data
collected for 7 months before and after intervention.
Results
There was a significant reduction in door to telestroke notification and neurologist
assessment after implementing the new process. Door to telestroke notification and
neurologist assessment were also strongly correlated.
Discussion
This project led to significant improvements in nurse-driven elements of the stroke
process. It demonstrates effective implementation of e-alert and collaboration with
telestroke services at an Acute Stroke Ready Hospital serving rural communities.
Key words
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References
- Heart disease and stroke statistics—2020 update: a report from the American Heart Association.Circulation. 2020; 141: e139-e596https://doi.org/10.1161/cir.0000000000000757
- An emergent large vessel occlusion screening protocol for acute stroke: a quality improvement initiative.J Neurosci Nurs. 2018; 50: 68-73https://doi.org/10.1097/jnn.0000000000000346
- Improving telestroke treatment times through a quality improvement initiative in a Singapore emergency department.Singapore Med J. 2019; 60: 69-74https://doi.org/10.11622/smedj.2018083
- The challenge of tightening door-to-needle timings in a telestroke setting: an emergency medicine driven initiative.Cureus. 2020; 12: e12316https://doi.org/10.7759/cureus.12316
- Thrombolytic therapies for ischemic stroke: triumphs and future challenges.Neuropharmacology. 2018; 134: 272-279https://doi.org/10.1016/j.neuropharm.2017.11.010
- Considerations for the implementation of a telestroke network: a systematic review.J Stroke Cerebrovasc Dis. 2022; 31106171https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106171
- Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes.Circ Cardiovasc Qual Outcomes. 2020; 13: 1-12https://doi.org/10.1161/circoutcomes.119.005903
- Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: stroke initiative.Stroke. 2011; 42: 2983-2989https://doi.org/10.1161/strokeaha.111.621342
- Variability and delay in telestroke physician alert among spokes in a telestroke network: a need for metric benchmarks.J Stroke Cerebrovasc Dis. 2019; 28104332https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104332
- Outcomes from a nursing-driven acute stroke care protocol for telehealth encounters.J Emerg Nurs. 2022; 48: 406-416https://doi.org/10.1016/j.jen.2022.01.013
- Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology.Stroke. 2021; 52: e133-e152https://doi.org/10.1161/strokeaha.120.033228
- Implementation of an institution-wide acute stroke algorithm: improving stroke quality metrics.Surg Neurol Int. 2016; 7: S1041-S1048https://doi.org/10.4103/2152-7806.196366
- Why Welch’s test is type I error robust.Quant Method Psychol. 2016; 12: 30-38https://doi.org/10.20982/tqmp.12.1.p030
- High variability in neuronal loss: time is brain, requantified.Stroke. 2019; 50: 34-37https://doi.org/10.1161/STROKEAHA.118.023499
- 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018; 49: e46-e99https://doi.org/10.1161/str.0000000000000158
- Improving door-to-needle times for acute ischemic stroke: effect of rapid patient registration, moving directly to computed tomography, and giving alteplase at the computed tomography scanner.Circ Cardiovasc Qual Outcomes. 2017; 10e003242https://doi.org/10.1161/CIRCOUTCOMES.116.003242
Biography
Bryce A. Kennedy is Stroke Program Coordinator, Catholic Health Initiatives Midlands Community Hospital, Catholic Health Initiatives Lakeside Hospital, Omaha, NE.
Biography
Pamela J. Stout is Service Leader Medical/Surgical Intensive Care Unit, Methodist Fremont Health, Fremont, NE.
Article info
Publication history
Published online: January 27, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
