Abstract Body: Background: Every minute is crucial in treating acute ischemic stroke (AIS), as the effectiveness of intravenous thrombolysis and endovascular therapy is highly time-dependent. AHA/ASA guidelines recommend door-to-needle (DTN) times of less than 60 minutes for at least 85% of AIS patients treated with IV thrombolytics, with further goals of achieving DTN times within 45 minutes for 75% of patients, and within 30 minutes for 50% of patients. However, less than a third of patients meet these time frames, prompting the implementation of a Launchpad protocol to hasten patient triage and intervention. This quality improvement initiative evaluates the Launchpad protocol's effectiveness at reducing DTN times in AIS treatment at an academic hospital, aiming to meet AHA/ASA guidelines and improve outcomes through a nurse-driven code stroke activation process. Fig.1. Updated Code Stroke Algorithm.
Methods: A multidisciplinary team was assembled to address DTN delays by pinpointing treatment barriers. While the nurse-driven code stroke activation process has been a crucial development, it still requires enhancements to optimize the rapid identification and management of AIS patients. The Code Stroke Launchpad, located adjacent to the CT suite, was launched on 7.18.2023. Previously, AIS patients were triaged to the next open ED room resulting in AIS patients broadly distributed over a 60 room ED. The Launch Pad allowed the centralization of care to a defined area in close proximity to the CT scanner as well as helped expedite the intervention and evaluation of the multidisciplinary care team. The effectiveness of this new protocol is evaluated by comparing time differences before and after the Launchpad's implementation.
Results: Post-Launchpad, door-to-needle times improved significantly: 84% of patients achieved the 60-minute target (up from 61%), 65% reached the 45-minute target (up from 39%), and 26% met the 30-minute target (up from 19%). Fig.2. Pre and Post DTN Averages
Conclusion: The Launchpad implementation significantly reduced DTN times. Ongoing enhancements in nurse training, communication, and support are needed. Introducing Stroke Champions could further boost compliance and response times by ensuring regular updates and better coordination.