Abstract Body: Introduction
Standardized stroke response protocols have been shown to reduce Door to Puncture (DTP) times for Acute Ischemic Strokes (AIS), potentially improving functional outcomes and reducing mortality. However, not all institutions can staff stroke-trained nurses 24/7. After-hours, these codes may be handled by staff less familiar with the process. To address increasing after-hours DTP times, radiology staff nurses designed and implemented an institution-specific, comprehensive educational stroke training program for all night shift ED nurses. The goal was to standardize stroke response and decrease DTP times during off-hours, ultimately improving patient care and outcomes in AIS cases.

Methods
Radiology staff nurses developed and implemented a comprehensive AIS training program for night shift ED nurses. The program consisted of a tailored PowerPoint presentation, a 3-hour small group educational in-service, and hands-on time in the angiography suite. Training focused on practical, actionable steps, including early identification of large vessel occlusion, proper patient preparation, and expedited transport from CT to angiography. One to two in-service sessions were provided monthly over a three-year period. To date, 43 ED nurses have completed the training program.

Results
Pre and post intervention DTP times were compared using Statistical Process Control (SPC) charts generated with data from June 2019 through December 2023 and a trend-line was applied. The year prior to project initiation (6/2019-6/2020), median DTP time was 69 minutes (trend line p-value 0.006). One year after project initiation (6/2021-12/2023), median DTP time dropped to 57 minutes (trend line p-value 0.028), a 12-minute decrease. This reduction time is equivalent to 22.8 million neurons saved and meets the National Stroke Standard goal of 60 minutes for DTP. The median time from "CT Complete" to "Patient in Angio" went from 20 minutes down to 5.

Conclusion
Standardized stroke training is paramount, particularly for hospitals facing constraints in round-the-clock stroke nursing resources or regulatory requirements. Institution-specific stroke education, including familiarization of patient transport routes and angiography suite location, is essential to reduce delays in DTP time. Harnessing the expertise of radiology staff nurses to provide standardized stroke education is a pivotal strategy for hospitals to meet quality outcomes for comprehensive stroke care.