Neuro-Alert: Hemorrhagic Stroke Expedited Transfer Process from ED to NCCU
Kaci Rainey, MSN, RN, CEN
- Sigma Affiliation
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Session D presented Friday, September 15, 2017
Purpose: We sought to develop a Neuro-Alert process for non-traumatic intracerebral hemorrhages in an effort to reduce transfer time from emergency department (ED) arrival to Neuro Critical Care Unit (NCCU) and bring the neurocritical care team immediately to the ED bedside.
Design: This project was designed as a performance improvement initiative between the ED and NCCU. This project aimed to decrease ED LOS, improve patient outcomes, increase patient safety and facilitate collaboration and communication across interdisciplinary departments.
Setting: Christiana Care Health System, located in suburban Newark, Delaware, is one of the country's largest health care providers, ranking 22nd in the nation for hospital admissions. Christiana Care is a major teaching hospital with two campuses with more than 1,100 patient beds and a third location with a free-standing ED. The system is home to Delaware's only Level I trauma center and Comprehensive Stroke Center.
Participants/Subjects: The participants were non-traumatic intracerebral hemorrhage patients who presented to Christiana ED and required admission to the NCCU.
Methods: Multiple baseline data points were collected from July 2015 to October 2015 including: mean ED arrival to NCCU arrival (288 minutes) , ED arrival to NCCU consult (148 minutes), NCCU consult to NCCU arrival (174 minutes) and CT Completion time to NCCU arrival (180 minutes).
An interdisciplinary team comprised of ED and NCCU bedside nurses, NCCU attending physician and the stroke program coordinator was developed to streamline the process between the ED and NCCU once the patient has been identified as a hemorraghic stroke. An algorithm was developed outlining the "Neuro-Alert" expedited process and all staff were educated in a timely manner. When a patient was idenfitied as a non-traumatic ICH or SAH, the ED physician would contact the NCCU physcian and activate a "Neuro-Alert". The "Neuro-Alert" activation alerts several key personnel, expedites admission to NCCU, improves communication among ED and NCCU departments, and alerts the NCCU Advanced Practice Nurse to respond to the ED and remain at bedside until patient is successfully transfered from ED to NCCU. The "Neuro-Alert" process went "live" on November 1, 2015.
Results/Outcomes: The same data points were collected from November 2015 to February 2016 following the initiation of the "Neuro-Alert" process. Overall, the mean ED arrival to NCCU arrival decreased by 60 minutes, the ED arrival to NCCU consult decreased by 37 minutes, the NCCU consult to NCCU arrival decreased by 58 minutes and the CT Completion time to NCCU arrival decreased by 44 minutes.
Implications: The impact of expedited transfer of a critically ill stroke patient from the ED to NCCU in a timely manner is paramount to improved patient outcomes. A study by Rincon et al (2010) shows that an ED LOS greater than 5 hours before transfer to the NCCU is independently associated with four times the increase of poor patient outcomes at hospital discharge. Many factors contribute to prolonged ED LOS and serve as barriers to expediting stroke patients to the NCCU. This project advocates for the hemorraghic stroke patient by matching their needs with immediate management by the Neurocritical Care team.
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