Time is Brain: A Quality Improvement Project to Improve Stroke Outcomes by Educating EMS. (P4.308)

Objective/Background: Benefit of intravenous (IV) rtPA for acute ischemic stroke is time dependent; delay in administering IV rtPA results in worse outcomes. EMS (Emergency Medical Services) plays an integral role in the management of acute ischemic stroke, and educating them can significantly improve outcomes. Methods: We analyzed the factors causing a delay in IV rtPA administration at our institute. Inability to contact family to review contraindications was the leading cause, especially in aphasic patients. We intervened by delivering lectures to various EMS groups at their headquarters. We emphasized the importance of time in stroke and how acquiring a family cell phone number can impact the time to IV rtPA, as a landline number is of little use if the family is en route. We also made reminder cards to be kept in ambulances and distributed them among EMS personnel. We analyzed the data after intervention to see the impact. Results: A total of 132 patients received IV rtPA at out center between July 2012 and June 2013. Twenty-nine were delayed beyond 60 minutes (22[percnt]), 13 of which were due to inability to contact family, accounting for 45[percnt] of the delays. Six months were spent spreading awareness among the EMS. Post intervention data from January 2014 to June 2014 was analyzed. Sixty patients received IV rtPA, 11 were delayed beyond 60 minutes (18.3[percnt]), only 3 of which were due to an inability to contact family, accounting for 27[percnt] of the delays. Conclusions: Acute stroke management requires a multidisciplinary team effort involving the EMS and stroke team. Contacting the family is essential to review contraindications in aphasic patients. Educating EMS about acute stroke management can help prevent delays in administrating IV rtPA. At our center we were able to decrease the number of delays by involving and educating the EMS. Disclosure: Dr. Singh has nothing to disclose. Dr. Sofat has nothing to disclose. Dr. Abdelhamid has nothing to disclose. Dr. Gaindh has nothing to disclose. Dr. Ahmad has nothing to disclose. Dr. Masud has nothing to disclose. Dr. Sawyer has nothing to disclose. Dr. Silvestri has received personal compensation for activities with Walgreens as a medical advisory board participant.