Optimizing Overall Management Times for Emergency Department Stroke Code Protocols - Lone Star Stroke Research Consortium
Yohan Kim1, Sidarrth Prasad1, Suzanne Stone1, Mehari Gebreyohanns1, Nneka Ifejika1, Erica Jones1, Kim Barker1, Sean Savitz2, Salvador Cruz-Flores3, Steven Warach4, Mark Goldberg5, DaiWai Olson1
1UT Southwestern Medical Center, 2UTHealth Houston, 3Paul L. Foster School of Medicine Texas Tech University Health Sciences Center, 4Dell Medical School, The University of Texas at Austin, 5UT Health San Antonio
Objective:
To identify patterns during stroke codes based on etiology (ischemic stroke, hemorrhagic stroke, and stroke mimics), which could serve as potential opportunities for improvement.
Background:
Stroke code performance metrics often focus on true acute ischemic stroke (AIS) cases and exclude intracerebral hemorrhage (ICH) and stroke mimics (SM). The NASCARE-3 study utilized insights from an expert panel within a statewide Texas research consortium to analyze stroke code activations for patients admitted to a tertiary stroke center in Texas on September 2024.
Design/Methods:
Stroke codes were categorized as AIS, ICH, or SM. Various metrics were then analyzed and categorized based on the diagnosis of the patient. All values were recorded as mean (SD). Statistical analysis used SAS v9.4 to build Kruskal-Wallis and Chi-Square models to explore omnibus differences.
Results:
The 123 stroke codes analyzed included 95 SM, 24 AIS, and 4 ICH. Significant differences were observed across groups in several metrics: diastolic blood pressure [89.0 (17.2) vs. 83.0 (16.6) vs. 113.5 (1.7) mmHg; P<.005]; NIHSS score [4.2 (6.4) vs. 6.5 (8.1) vs. 16.5 (12.3); P<.05]; door-to-ED physician arrival times [60.6 (173.3) vs. 115.1 (184.3) vs. 23.5 (47.0) minutes; P<.05]; door-to-stroke team arrival times [135.8 (281.6) vs. 182.8 (153.9) vs. 48.5 (97.0) minutes; P<.005]; door-to-imaging times [90.1 (196.7) vs. 82.2 (78.5) vs. 21.0 (29.4) minutes; P<.01]; and door-to-glucose time [61.7 (175.7) vs. 42.8 (58.3) vs. 6.8 (11.6) minutes; P<.04].
Conclusions:
These results highlight the importance of refining stroke code processes regardless of different stroke subtypes, as significant variations in key metrics such as door-to-ED physician arrival, door-to-stroke team arrival, and door-to-imaging times were observed. Placing equal emphasis on the stroke code process for all stroke differentials offers significant potential to enhance hospital quality improvement initiatives. Implementing a go/no-go model for stroke code activation across hospital systems could enhance both efficiency and patient care.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.