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?