Stroke Alert at Lutheran General Hospital, Park Ridge, IL

1. Lynn Michel, RN, MSN, APN / CNS Stroke Alert at Lutheran General Hospital, Park Ridge, IL

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

3. 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 Pre-Stroke Alert

4. 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

5. 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.

6. 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

7. The beginning….6 months prior to starting • Stroke Coordinator • Stroke Team Neurologist • ED Medical Director • Critical care director • Hospital Operator

8. 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

9. 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

10. 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 in-house strokes

11. 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”

12. Stroke Alert 1 year later

13. 196 stroke alerts in 2007 1st quarter of 2007 57 1st quarter of 2008 53 How many?

14. Where do the Stroke Alerts Happen at LGH?

16. Inpatients CT times

17. Door to CT times for ER patients

18. The use of tPA increased by 64% in the ER

19. 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

20. 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 don’t qualify for tPA Barriers 1 year out

21. Questions?