Background: Timely evaluation and treatment are essential to optimizing outcomes in ischemic and hemorrhagic stroke. National guidelines emphasize rapid provider response and multidisciplinary coordination. In complex settings such as inpatient units, delays in decision-making and care coordination can hinder time-sensitive interventions, including thrombolysis and thrombectomy. Purpose: As part of a broader institutional focus on continuous quality and process improvement (QI/PI) in stroke care, this project evaluated treatment time trends following integration of Advanced Practice Providers (APPs) into the acute stroke response workflow at a Comprehensive Stroke Center (CSC). The analysis focused on door-to-needle (DTN) and door-to-device (DTD) times for stroke alerts in inpatient units and the Emergency Department (ED). Methods: In Fiscal Year (FY) 2021, eight APPs were incorporated into the hospital-wide stroke response team. APPs were trained in acute stroke protocols and began responding in real time to stroke alerts across all hospital settings, assisting with rapid triage, examination, imaging review, and coordination with interventional teams. In FY24, three additional APPs joined the inpatient team, increasing coverage from 64% to 86%. Time metrics for ED and inpatient stroke activations were compared pre- and post-APP integration and monitored annually as the APP team expanded. Descriptive statistics were used to evaluate changes in treatment intervals. Results: Among inpatients, median DTN for thrombolysis decreased by 33 minutes and median DTD for thrombectomy by 37 minutes. For ED patients, median DTN decreased by 4 minutes and DTD by 34 minutes. Adherence to Get With The Guidelines (GWTG) target stroke measures also improved across all settings. The most significant improvements were seen in inpatient cases, where delays were historically greatest. Conclusions: As part of broader institutional efforts to enhance stroke care quality and efficiency, integration of APPs into the acute stroke response workflow was associated with improved key treatment time metrics. While not the sole intervention, APP integration did not extend and may contribute to reduced time to evaluation and treatment, particularly in complex inpatient settings. This experience provides valuable insights for health systems seeking to enhance multidisciplinary stroke care through scalable, team-based innovations.
Stein et al. (Thu,) studied this question.