Evaluation of Emergency Department Factors on Acute Ischemic Stroke Treatment
Melanie Aluotto, MSN, RN, CEN; Terence Chau, PharmD, BCPS; Nicholas Yarbrough, PharmD; Sapana Desai, PharD, BCPS; Donald Garrett, BSN, RN, CEN, LP; Huy Liem Pham, BSN, RN; Jesus Ledesma, RN
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Session A presented Thursday, September 14, 2017
Purpose: The objective of the study was to describe the relationship between emergency department factors and the timing of thrombolytic administration for acute ischemic stroke patients presenting to a community emergency department. Memorial Hermann Memorial City Emergency Department implemented a “Code Stroke” alert which consists of rapid triage, the involvement of a multi-disciplinary team, and expedited laboratory turnaround times for suspected acute ischemic stroke patients.
Design: This study was an IRB-approved retrospective quality assurance project of Memorial Hermann Memorial City’s Code Stroke pathway.
Setting: The retrospective chart review was conducted at Memorial Hermann Memorial City Medical Center in Houston, Texas. Memorial Hermann Memorial City is a 479-bed community hospital with a designation as a Primary Stroke Center.
Participants/Subjects: Inclusion criteria included adult patients (≥18 years old) with a primary or secondary diagnosis of ischemic stroke and received alteplase for the treatment of acute ischemic stroke at Memorial Hermann Memorial City Medical Center Emergency Department between 2/1/2011 and 9/1/2015. Exclusion criteria included patients < 18 years old, alteplase administration for the treatment of indications other than acute ischemic stroke, and pregnancy.n=148.
Methods: Data collection was performed from the patient’s electronic medical record. Data collected included but was not limited to: patient demographics, patient clinical data, and ED crowding factors. ED crowding factors included but was not limited to: total number of ED patients; number of treated ED patients; number of admitted ED patients; ED patient complexity; number of ED admits; admission percentage; time between arrival to triage and provider assignment.
The primary endpoint of the study was to evaluate the relationship between emergency department factors and lower door-to-thrombolytic times for acute ischemic stroke patients. Secondary endpoints were to evaluate the impact of Memorial Hermann Memorial City’s Code Stroke clinical pathway on door-to-thrombolytic times for acute ischemic stroke patients and the impact of the inclusion of emergency department clinical pharmacy services and phlebotomists (i.e. multi-disciplinary approach) on door-to-thrombolytic times less than 60 minutes.
Results/Outcomes: Data collection is ongoing. Preliminary results are presented. A total of 148 patients were included in the study. Between patients with door-to-needle times 60 minutes versus patients with door-to-needle times > 60 minutes, there were no significant differences in the measured daily ED crowding factors (door to triage, ED volume, number of treated patients, patient complexity, number of admissions, admission percentage, arrival to triage, arrival to bed, arrival to provider assignment, arrival to admission, arrival to discharge/depart).
Implications: Research is ongoing. Future directions include continuation of data collection and analysis of the final results. The final data will assist in the identification of areas for improvement. Preliminary data suggest the current Code Stroke pathway and its associated door-to-needle times are not impacted by daily ED crowding factors.
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