Stroke Alert at Lutheran General Hospital, Park Ridge, IL

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Stroke Alert at Lutheran General Hospital, Park
Ridge, IL

• Lynn Michel, RN, MSN, APN / CNS

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Stroke Alert

• Stroke Alert started on 01/01/07
• 700 bed suburban teaching hospital
• Level I Trauma Center

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Pre-Stroke Alert

• Emergency room
• Patient triaged as priority 3 or 4 / 5
• CT ordered along with other stat ER orders

• In-House patients
• Physician notified of patients change in
  condition
• CT if ordered was ordered stat
• Neurology consult if ordered

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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

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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.

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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

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The beginning.6 months prior to starting

• Stroke Coordinator
• Stroke Team Neurologist
• ED Medical Director
• Critical care director
• Hospital Operator

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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

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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

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Nursing Considerations

• Call x 213333 and report that you have a Stroke
  Alert
• The operator will page
• Stroke Alertand unit name
• or Stroke AlertER
• RRT will be paged and respond to in-house strokes

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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

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Stroke Alert 1 year later
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How many?

• 196 stroke alerts in 2007
• 1st quarter of 2007
• 57
• 1st quarter of 2008
• 53

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Where do the Stroke Alerts Happen at LGH?
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(No Transcript)
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Inpatients CT times
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Door to CT times for ER patients
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The use of tPA increased by 64 in the ER
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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

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Barriers 1 year out

• MYTHS
• Physicians and nurses believe that Stroke Alert
  is only for those patients who qualify for tPA

• TRUTH
• 10-15 of all strokes are hemorrhagic which also
  need emergency treatment
• LGH has a stroke research project for ischemic
  stroke patients who dont qualify for tPA

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Questions?