Abstract Body: Background and Purpose: Upon a retrospective review at two community based acute care hospitals our team determined an evidence based orderset was not selected at admission for all patients with an ischemic stroke leading to missed assessments and patient education opportunities. The purpose of this project was to evaluate the impact of a nursing delegate paired with a virtual neurologist on improving utilization of the stroke order set, documentation of Modified Rankin Scale (mRS) and stroke education delivery to patients and caregivers piror to discharge from the hospital.

Methods: Utilizing the PDSA methodology, we studied the impact of adding a nurse delegate to rounds paired with a virtual neurologist to improve stroke care documentation at two acute care community hospitals. A virtual neurologist rounded on all patient consults using video camera technology and a nurse delegate at the bedside. Beginning in April of 2024 the nurse delegate identified patients with an admission diagnosis of stroke and checked for presence of the ischemic stroke orderset prior to virtual rounds. If the order set was missing, a message reminder was sent to the attending physician team to place the order set, or the neurologist would place during patient rounds. Placement of the order set added reminders to nursing task lists to complete mRS scores and education. The nurse delegate would provide the patient education and document completion prior to the patient discharge if not completed by the primary nurse team.

Results: Prior to the initiation of the intervention, at hospital A, the baseline date showed of 154 patients with an ischemic stroke only 69 (45%) had a stroke order set on their chart. After the initiation of the nurse delegate the use of the order set improved to 12 out of 15 (80%). This was above the facility stretch goal of 78%. At hospital B, 17 out of 30 stroke patients (56.7%) had documented mRS recorded on admission after the addition of the nurse delegate 24 out of 24 patients had completed scores. At hospital B the stroke education documentation increased from 12 out of 13 (92%) to 12 out of 12 (100%).

Conclusion: The addition of nursing delegates to virtual neurology rounds in the workflow for stroke patients improved communication,documentation and care coordination between the neurologist and the primary care team members, patients, and caregivers. Early inclusion of the orderset improves documentation of mRS and stroke education.