Abstract Body: Introduction:
Advanced Practice Providers (APP) are being integrated into more medical sub-specialties and opportunities may exist to increase the acuity of the patients they serve. We evaluated whether utilizing an APP in the emergency room affected timing and safety of IV thrombolytic therapy.
Methods:
Single center academic hospital retrospective analysis on acute ischemic stroke patients given thrombolytic therapy in the emergency department between January 2022 and June 2024. Patients treated greater than 4.5 hours of symptom onset and those with non-disabling symptoms upon emergency room arrival were excluded. Primary outcome: door to needle (DTN) time of the APP versus neurology residents using quantile (median) regression adjusted for age, NIHSS and delays for treating hypertension. Secondary outcome evaluated symptomatic intracranial hemorrhage (sICH) post thrombolysis comparing APP versus neurology residents using Fisher’s exact test. To evaluate for potential time confounds due to the APP’s working schedule, a subgroup analysis compared patients treated by neurology residents during APP scheduled work times to APP off hours using quantile (median) regression adjusted for aforementioned cofounding variables.
Results:
There were 278 patients given thrombolytic therapy in the emergency room and after exclusions 271 patients were included in the study and all analyses. The APP had a lower median DTN time than the neurology residents, 32 minutes versus 54 minutes. After adjusting for confounding variables the APP treated patients 18.98 [95% CI 5.11, 32.85] minutes quicker than neurology residents, p=0.008. Rates of sICH were similar between the APP and neurology residents, 0(0%) versus 5(1.9%), p>0.99. Neurology resident DTN times remained consistent when covering APP shift and outside of APP scheduled hours, adjusted median difference in door to needle time, 2.50[95% CI -11.43,16.44], p=0.72.
Conclusion:
The utilization of an APP who specializes in treating ischemic stroke patients with thrombolytic therapy provides safe and fast administration. APPs may be used to respond to emergency room stroke alerts to determine eligibility and administration of thrombolytic therapy.