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Lynn Michel, RN, MSN, APN / CNS. Stroke Alert at Lutheran General Hospital, Park Ridge, IL. Stroke Alert. Stroke Alert started on 01/01/07 700 bed suburban teaching hospital Level I Trauma Center. Emergency room Patient triaged as priority 3 or 4 / 5

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Lynn Michel, RN, MSN, APN / CNS

Stroke Alert at Lutheran General Hospital, Park Ridge, IL


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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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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


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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 Alert…and unit name”

  • or “Stroke Alert…ER”

  • 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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196 stroke alerts in 2007

1st quarter of 2007

57

1st quarter of 2008

53

How many?






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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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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



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