Stroke Response Team
Stroke Alert at Lutheran General Hospital, Park Ridge, IL Lynn Michel, RN, MSN, APN / CNS Stroke Alert Stroke Alert started on 01/01/07 700 bed suburban teaching hospital Level I Trauma Center Pre-Stroke Alert Emergency room In-House patients Patient triaged as priority 3 or 4 / 5 Physician notified of patients change in condition CT ordered along with other “stat” ER orders CT if ordered was ordered “stat” Neurology consult if ordered Why do a Stroke Alert? As a Primary Stroke Center we wanted to have a process in place to: Expedite the assessment and treatment of patients experiencing stroke symptoms. To decrease the “Door to CT time” to 25 minutes or less for ER and inpatients experiencing stroke symptoms less than 3 hours in duration Why is a Stroke Alert important? tPA can reverse an Acute Ischemic Stroke but must be given within 3 hours of symptom onset Interventional procedures now available Hemorrhagic stroke is also an emergency and may require surgical intervention. Hemorrhagic Stroke 10-15% of all strokes… 37,000 to 52,400 new cases / year Incidence: 15 per 100,000 individuals / year Rate expected to double by 2050 African-American and Japanese: incidence is twofold than in Caucasians 35 to 52% 1 month mortality Only 20% were living independently by 6 months The beginning….6 months prior to starting Stroke Coordinator Stroke Team Neurologist ED Medical Director Critical care director Hospital Operator Stroke Alert Based on the “Code Yellow” and “Cath Lab Alert” We chose to call it “Stroke Alert” and not another “coded name” This increases awareness to staff and lay people that stroke is an emergency What we needed: •Provide rapid diagnosis and treatment of stroke. (RRT for inpatients) •Written protocols (time frame) for assessment and treatment. (RRT) •CT to get a scanner prepared •tPA if appropriate (tPA on call list) •Neuro-Surgery if appropriate Nursing Considerations Call x 213333 and report that you have a “Stroke Alert” The operator will page “Stroke Alert…and unit name” or “Stroke Alert…ER” RRT will be paged and respond to inhouse strokes Nursing considerations CT department will get a CT scanner ready for the patient. Nurse can call RRT first who then will assess and call the “Stroke Alert” Stroke Alert 1 year later How many? 196 stroke alerts in 2007 1st quarter of 2007 57 1st quarter of 2008 53 Where do the Stroke Alerts Happen at LGH? Stroke Alerts by Location Inpatient, 23% ER 77% Number of Stroke Alerts What inpatient units? 30 25 Telemetry 20 Medical 15 Orthopedics 10 Surgical 5 Stepdown ICU 0 Rehab 1 Inpatient Units Behavior health Inpatients CT times Inpatients CT times 40 2008 2007 30 20 10 0 Series 1 1 2 34 28 Time frame Door to CT times for ER patients 50 45 2006 Minutes 40 35 30 25 20 2007 15 10 5 0 1 2 The use of tPA increased by 64% in the ER tPA given Number of patients 20 2007 15 2006 10 5 0 1 Lessons learned Pharmacy became involved to start the tPA checklist There was “over calling” in the beginning Need to orient new personnel Need to change time criteria to reflect IA tPA and research study time frames Barriers 1 year out MYTHS: TRUTH Physicians and nurses believe that Stroke Alert is only for those patients who qualify for tPA 10-15% of all strokes are hemorrhagic which also need emergency treatment LGH has a stroke research project for ischemic stroke patients who don’t qualify for tPA Questions?