Introduction: Stroke is currently under treated by many major medical centers across the country. Timely recognition and treatment of acute ischemic stroke remains a challenge due to confusing clinical presentations, hospital logistics, communication barriers among providers, and lack of standardized treatment algorithms.
Methods: We created a streamlined fully accountable process called “code stroke”. When a patient presents to ED with signs of symptoms of a stroke, triage assessment is completed within 5 minutes. Patients who meet criteria are placed in a high acuity ER bed. ED physician evaluates patient within 10 min, confirms stroke symptoms, generates an NIHSS score, and prepares patient for CT. A Code Stroke is activated. An automated alert is sent to the on-call stroke neurologist, neuroendovascular surgeon, CT tech, radiologist, ED operational manager, bed coordinator. CT Brain with Perfusion is performed from 16-45 min, and a final radiologist read is available within 15 min of completion of study. The ER physician, neurologist, and neuroendovascular surgeon confer and reach consensus on a treatment recommendation. IvtPA is stocked in the ED and is started within 60 min from presentation. Neurologists, neuroendovascular surgeons, and radiologists are benchmarked with regard to response times, treatment rates, and outcomes.
Results: After implementing code stroke, our ivtPA administration rate increased from 2% to greater than 10%, NIHSS documentations approaches 100%, specialist call back time reduced from 8 to 2 min, and CT interpretation decreased from 26 to 8 min, and neuroendovascular intervention increased from a handful to 40-70 cases annually.
Conclusions: By creating a “code stroke” protocol, we have demonstrated significant improvement in the diagnosis and treatment of stroke patients with objective, measurable improvement in outcomes. The process was subsequently scaled to a system level and then to a network level. Our protocol may be used as a model for other centers to enhance their stroke programs.
Patient Care: Stroke is currently under treated by many institutions due to difficulties in identifying and triaging these patients. Our Code Stroke protocol is time tested, and has been modeled by many other health systems with objective, measurable, and reproducible results. This can have tremendously impact on the health of our population and fills in a diagnostic and treatment gap for this patient population that's currently exerting significant socioeconomic burden for our country.
Learning Objectives: By conclusion of this session, participants should be able to: 1) recognize that acute ischemic stroke is a neurosurgical concern and that endovascular neurosurgeons can be an important part of a multispecialty stroke team, 2) understand that a standardize algorithm can help with improving outcomes and identify appropriate candidates for neuroendovascular intervention, 3) identify barriers and understand hospital logistics in order to create an algorithm or process suited for their own institution for patients with acute ischemic stroke.