Background: Neuroscience nurses are trained to understand neurological conditions and identify changes in patient presentation, indicating degradation of medical status. Typically, neuroscience nurses receive focused education on assessment of neurologic symptoms; they are commonly required to be National Institute of Health Stroke Scale certified. The relationship between neuroscience-specific education/ NIHSS certification and resultant correct identification of changes in neurological condition or positive new stroke diagnosis on different hospital units is our focus of study. Methods: We analyzed 6 months of Comprehensive Stroke Center inpatient stroke code data (310 patients). We focused on volume of stroke codes called on designated neuroscience units (stroke, neurosurgery and neuro/surgical critical care) versus typical med-surg units and evaluated accuracy of stroke or neurologic diagnosis from an inpatient stroke code, validated by positive MRI or other neurodiagnostic testing. We also analyzed volume and accuracy of inpatient stroke codes in cardiac surgery/general cardiology units, with known heart-brain connection and high incidence of stroke as secondary complication of cardiac interventions. Results: Accuracy of identification of positive new stroke diagnosis is similar on neuroscience units, comparative to all other units (table 1). However, accuracy of identification of new stroke diagnosis on cardiac units was higher than general med-surg and neuroscience units (table 2). Additionally, the volume of stroke codes called on cardiac units during this data capture period was higher than neuroscience or other med-surg units. Conclusion: This analysis demonstrates the importance of neurologic assessments on cardiac units. A higher number of new stroke cases were identified on cardiac units. On neuroscience-specific units, it is unknown if stroke symptoms (and ultimately a new stroke diagnosis) were managed without an inpatient stroke code, due to neuroscience nurses’ sensitivity to acute neurological changes and NIHSS assessments. The volume of new stroke cases on cardiac units may be higher, as some neurologic symptom demonstrations may be incorrectly associated with other cardiac conditions or residual anesthesia affects and not identified with an inpatient stroke code. In conclusion, this analysis raises the question of whether cardiac nurses should have focused neurologic assessment education including NIHSS certification.
DeWald et al. (Thu,) studied this question.