Abstract TP362: Implementation of a Stroke Response Nurse to Decrease Door to Groin Puncture Times in Patients Undergoing Endovascular Intervention for Acute Ischemic Stroke

Abstract

Background: A focus on timely reperfusion is a key component to improving outcomes for patients with acute ischemic stroke undergoing endovascular procedures. Since there are many patient factors such as vascular anatomy and procedure tolerance that cannot be controlled, the ability of endovascular centers to expedite the pre-groin puncture process including pre-procedure imaging and assessments is key to achieving reduction of door to reperfusion times. Methods: A Plan-Do-Study-Act (PDSA) improvement cycle revealed a baseline process that was cumbersome with delayed door-to-groin (DTG) puncture times. A key experiment in the PDSA cycle included implementation of a Stroke Response Nurse (SRN) to improve DTG puncture times for patients transferring from outside hospitals. The responsibility of the SRN included meeting the patient and the neurology team at a new point of entry (CT scan) in order to provide ICU-level care, bringing a stroke treatment bag with needed monitoring equipment, supplies and medications, facilitate assessments and stabilization of the patient. After initial assessments and imaging are completed, the SRN transports the patient directly to the endovascular suite and hands off care at the bedside to the interventional team. Results: Pre-implementation analysis revealed a mean DTG puncture time of 134.3 minutes. In 2015, this time was reduced to 64.4 minutes with a further reduction noted in 2016 to 47.3 minutes. Overall, the implementation of the SRN resulted in a reduction in DTG puncture times of 64.8% from pre-implementation. Door to first pass of thrombectomy device also decreased from 106.2 minutes in 2015 to 73.5 minutes in 2016. Conclusions: Patients in need of endovascular therapy for acute ischemic stroke require ICU-level expertise to help with stabilization and treatment upon arrival. In addition, expediting pre-procedure imaging and decision making is key to reducing DTG puncture times. Implementation of an SRN can help to facilitate direct-to-CT scan patient arrivals and evaluations which have led to significant reductions in DTG puncture times.