Abstract NS 6: Community Hospital Nurse-Led Stroke Team Improves IVtPA Treatment Rates

Background: Our 350-bed community hospital in the rural Midwest has been designated as a Primary Stroke Center (PSC) since 2005. Under general neurologist leadership, our 2007-2008 intravenous (IV) tPA treatment rate was 9% with no sICHs and an average 65 minute Emergency Department (ED) door to bolus time. We sought to understand the effect of post-graduate acute neurovascular fellowship advanced practice nurse (APN) education/training and nurse-led Stroke Team leadership on our PSC IVtPA treatment rates. Methods: Our APN Stroke Coordinator enrolled in the NET SMART-AP program in September 2008 and graduated in 2009 becoming one of the first acute neurovascular post-graduate educated/trained APNs in the world. The APN led development of nurse-led Stroke Team consisting of a Stroke Coordinator and 2 stroke data abstractors. A report card system was created to provide continuous feedback on process and outcome measures to staff nurses, ED physicians, EMS, and general neurologists. Individual “case” feedback was relayed within 24 hours to all stakeholders and aggregated quarterly into a benchmark report card to stimulate competition/improvement within the pre-hospital and hospital settings. The nurse-led Team responded to Stroke Alerts and provided rapid communication to general neurologists about suspected vascular territory by clinical localization, CT results, suspected pathogenic mechanism, and made recommendations for IVtPA treatment. Numerous improvements were implemented including, ongoing interdisciplinary hospital, EMS and community education, and an Acute Stroke Emergency Toolkit. IVtPA treatment rates and sICH rates were tracked alongside stroke admission numbers for the duration of the project. Results: In 2009, a total of 165 acute stroke patients were admitted; of these, 148 were ischemic strokes and 15% (n=19) were treated with IVtPA (sICH rate=0). In 2010, a total of 173 acute strokes were admitted; of these, 152 were ischemic strokes and 21% (n=32; p<0.08) were treated with IVtPA (sICH rate of 0). ED door to bolus time decreased from 65 minutes on average in 2007-2008, to 60 minutes in 2009 and 54 minutes in 2010 (p=ns). Satisfaction with the nurse-led Stroke Team is uniformly high among physicians, nursing staff, and administrators, with general neurologists voicing confidence in Team performance and decision making. Conclusion: Acute neurovascular fellowship education/training supports development of nurse-led Stroke Teams, safely improving IVtPA treatment rates for acute ischemic stroke, and providing a convenient mechanism for community general neurologists to respond to stroke call.