Implementing a Stroke Narrator and Stroke Team Debrief to Improve Transfer Times

Abstract

Problem. According to the American Stroke Association (2020), strokes represent the fifth cause of death and the leading cause of disability in the United States. The Brain Attack Coalition recommends transferring stroke patients requiring advanced management within 120 minutes. In 2019, the host organization, a Primary Stroke Center, managed over 700 strokes per year and completed more than 100 transfers to Comprehensive Stroke Centers (CSC). The host organization has multiple procedures to help identify, diagnose, and treat strokes but struggles to consistently reach the recommended transfer times of less than two hours. Purpose. The purpose of this quality improvement (QI) project was to reduce the door-to-transfer times for large vessel occlusion and hemorrhagic strokes, requiring a higher level of care at a CSC. Methods. The QI project's primary goal was to achieve a door to transfer time of less than two hours. Key best practice strategies, including clinical supporting tools as the Electronic Medical Record (EMR)- embedded nurse narrator and a clinical debrief, were conceptualized to improve patient outcomes. Results. The current data did not suggest a statistically significant reduction in transfer times but displayed a clinically significant reduction in large vessel occlusion transfer times during the implementation period. The use of the stroke debriefs was not analyzed thoroughly due to a limited completion of the Stroke Debrief forms, with only 20% completion of the forms. Additional education and training were conducted to ensure compliance with new stroke care procedures. Conclusion. The use of prompt feedback to the Emergency Department staff assists with identifying deviations from the current stroke algorithm, errors, and provides lessons learned. These lessons learned could be applied to future stroke transfers resulting in the improvement and achievement of transfers in less than two hours.