Abstract DP277: BREAKING THE CLOT CLOCK: OPTIMIZING OUTCOMES BY STREAMLINING ED STROKE ACTIVATION PROCESSES

Background: Timely neuroimaging is critical for rapid treatment of acute ischemic stroke. Guidelines recommend less than 25 minutes elapse from arrival to CT (Hennebry, et.al, 2022). However, at a 77-bed comprehensive stroke center emergency department, the goal of activating a stroke in under 10 minutes was achieved at a rate of 70%, while arrival to CT in under 20 minutes was met 51% of the time. Optimization was hindered by a new facility layout, a staff of 300 nurses and techs, and multiple modes of patient arrival. Process improvements were needed to increase the rate at which the door to CT goal was achieved. Purpose: To improve door to activation and door to CT start times by 15% though implementation of a multidisciplinary hyperacute stroke activation process at a comprehensive stroke center. Methods: A multidisciplinary team was assembled with representatives from nursing, emergency medicine, patient registration, stroke program leadership and patient safety to address door to activation and door to CT delays by identifying treatment barriers. Initiatives were implemented simultaneously to the hyperacute activation (HAS) process. Initiatives included: Pre-activation of transfers and EMS arrivals, utilization of COST acronym in tandem with a nurse-driven CT standing order, standardization of location for stroke handoff, offloading of EMS patients on CT scanner table, and pre-activation of order sets by ED physicians on transfers. Baseline data compared pre- and post-initiative implementation. Data analyzed percentages of time that door to activation was less than 10 minutes and percentages of time that door to CT start was less than 20 minutes. Results: Door to activation in less than 10 minutes increased by 15%. Door to CT start in under 20 minutes increased by 23%. Additionally, initiation of the nurse-driven CT standing order for stroke compliance reached 67% during the evaluation period. Conclusion: Implementation of a nursing-led stroke activation process, creation of a standing order for stroke imaging, and establishment of a standardized communication with the multidisciplinary team supports delivery of rapid evaluation and treatment for acute stroke patients in the emergency department.