Early recognition and identification of patients having a stroke, and subsequent administration of thrombolytics within 60 minutes, can lead to improved patient outcomes and reduce disability and mortality. Arrival by Emergency Medical Services (EMS) and pre-notification among ischemic stroke patients are well-established to improve the timeliness and quality of stroke care. Identification of a low compliance of pre-notification and prolonged door-to-thrombolytic time not within the 60-minute goal motivated nurses to lead an interprofessional quality project to improve the structure of increasing this compliance and reducing the door-to-thrombolytic time in the ED with the implementation of a pre-notification tool and education.
Problem: An acute care hospital had a pre-notification compliance from EMS to ED triage as low as 11%. This negatively impacted door-to-thrombolytic time, which was averaging 85 minutes, far above the goal of 60 minutes. The goal was to expedite provider assessment and activation of Code Grey, subsequently reducing door-to-thrombolytic time.
Measurement: A line graph was utilized to measure if the door-to-thrombolytic time decreased to meet the goal of 60 minutes.
Analysis: Analysis of this quality improvement project included measuring compliance of the pre-notification tool and subsequent results of the door-to-thrombolytic time in the ED after implementation. Data was shown in a line graph.
Implementation: A pre-notification tool was implemented to increase communication between ambulance triage and receiving zone nurses. Education was provided to EMS partners and ED staff regarding standardized screening. HCQPs can learn how to activate a stroke team before a patient arrival to the ED to expedite patient care and improve outcomes.
Results/Discussion: A new pre-notification tool and improved education resulted in earlier notification and ED nurses being better prepared with tPA, thereby reducing door-to-thrombolytic time, and providing more rapid stroke patient care. We continue to monitor documentation and provide feedback to both the ED staff and EMS.
