Abstract Body: Background: During continuous quality improvement review, multidisciplinary opportunities were identified to help improve the care of large vessel occlusion (LVO) patients across several departments within the study institution. Major stakeholders met to develop a distinct pathway for these patients including streamline activations, participation of anesthesia, and defined roles and responsibilities for all departments involved in the care of these patients.
Purpose: With an overarching goal to decrease door-to-puncture times, several opportunities were identified as part of the ongoing review process. Opportunities included: streamlining the activation of LVO interventions, decreasing activation times of the interventional radiology team, participation of anesthesia in all LVO cases, as well as forming an interdisciplinary approach for patient transfer to the interventional suite. In efforts to streamline the inter-departmental care, clear and defined nursing responsibilities and roles were delineated in the pathway.
Methods: An LVO pathway was developed with the interdisciplinary team including stroke program coordinator, managers and executive leadership, neurologists, interventional radiologists, emergency and critical care physicians, pharmacists, and nursing. Defined nursing roles included transport of the patient from the emergency department to the interventional suite, response to the interventional suite by the critical care team, preparation of the patient, anesthesia roles, and transport of the patient to critical care post-thrombectomy.
Results: Data was reviewed for one year prior to LVO pathway implementation and one-year post-implementation to include a total of 156 cases. The median door-to-puncture time one year prior to the LVO pathway was 115 minutes compared to 87 minutes post implementation, a 24% decrease (Table 1). During intervention debriefing review it has been identified by the team that the delineated roles, specifically during transportation and arrival to the interventional suite has greatly impacted our overall door-to-puncture times.
Conclusion: The utilization of an LVO pathway to include assigned nursing roles was instrumental to decreasing door-to-puncture times at the study institution. This pathway may be generalizable to other large, academic tertiary referral institutions to promote optimal outcomes in this critical patient population.