Abstract Body: Background and Purpose
In 2023, High Point Medical Center implemented a quality improvement initiative to enhance outcomes for hospitalized patients experiencing strokes. This initiative was created after review of cases entered in a patient event reporting system. Root cause analyses of the reported events identified multiple opportunities for improvement. An interdisciplinary initiative was launched that engaged stakeholders from patient safety, the stroke team, and nursing education. The project team concentrated on implementing hospital-wide strategies aimed at preventing harm by enhancing stroke symptom recognition, stroke alert activations, and the execution of the code stroke protocol for inpatient stroke alerts. The purpose of this quality improvement initiative was to increase the quantity and quality of code stroke activations among hospitalized patients.

Methods
Patient volumes from 2022 and 2023 were trended in Get with The Guidelines and compared to the Stroke Data Bank. Our intervention consisted of comprehensive education for all clinical staff including symptom recognition, stroke simulations, and empowering nurses to activate stroke alerts immediately upon suspicion of stroke. Interventions were initiated in quarter two of 2023 and continued throughout the year.

Results
Initial analysis of patient volumes determined that our hospital had fewer recognized inpatient strokes than anticipated for our size. Reported safety events concluded that stroke events were not consistently recognized or implemented in a timely manner. After the intervention, surveys indicated that staff experienced a heightened awareness of signs of stroke and knowledge of their roles in the code stroke process. Inpatient code stroke activations tripled from quarter one to quarter four after the interventions. The number of patients receiving intervention quadrupled by the end of quarter four. Nurses identified stroke symptoms and had gained the confidence to independently activate a code stroke. A culture of stroke advocacy and reporting of events was formed.

Conclusions
Increasing stroke symptom awareness through symptom recognition, stroke simulation, and empowering nurses to activate stroke alerts improved patient care and outcomes for those who experienced a stroke while hospitalized. Staff recognition of stroke symptoms increased, resulting in more inpatient stroke alerts, thrombolytic administrations, and thrombectomies for acute ischemic strokes.