Stroke Response Team
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Transcript 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?