Performance of a New “Code Stroke” Process in Hospitalized Patients in a Comprehensive Stroke Center in Minnesota (P6.005)

Objective: This study describes the impact of revising an in-patient stroke protocol. Background: Literature suggests that stroke in hospitalized in-patients is under-recognized and the morbidity and mortality rates of in-patient strokes exceed those of out of hospital stroke. Efficient team processes play a factor in a favorable prognosis for hospitalized patients suspected of having a stroke. Design/Methods: A new in-patient stroke protocol was implemented as a quality improvement project. The focused actions included nursing education, introduction of documentation tools, and communication of the quality metrics in a process whereby the bedside nurse activates ‘Code Stroke’ using same criteria as used by EMS and ED triage nurses. Code Stroke activates a specialized stroke team and clears the CT scanner. Feedback was provided in real-time and in writing to the participating care team. The analysis utilized a prospectively maintained database of inpatient stroke, feedback communications, and chart review. The metrics used to examine the performance of the new process were: rate of stroke symptoms identification, errors in paging, errors in documentation, time to CT, and outcome of code activation. Results: In the 6 months prior to the new protocol, a ‘Code Stroke’ was activated 5 times, only one was a true stroke and was treated with thrombectomy. In the 6 months after the new protocol, ‘Code Stroke’ was activated 46 times, with 15 confirmed strokes (14 ischemic, 1 hemorrhagic). A change in care occurred for 13 patients, including IV alteplase (n=2), thrombectomy (n=1), change in medical management (n=9), and decompressive hemicraniectomy (n=1). Mean time for Code Stroke to CT was 26 minutes despite errors in pages (wrong call back number, incorrect code designation). Conclusions: The new process increased detection and treatment of in-patient strokes. Elements of success include system-wide organization, simplifying the process, mirroring ED process, and availability of stroke response team. Disclosure: Dr. Droegemueller has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with The Joint Commission. Dr. Wagner has nothing to disclose. Dr. Kashyap has nothing to disclose. Dr. Clayton has nothing to disclose. Dr. Fennig has nothing to disclose. Dr. Hanson has nothing to disclose. Dr. Hussein has nothing to disclose.