OUTCOMES FROM A NURSING-DRIVEN ACUTE STROKE CARE PROTOCOL FOR TELEHEALTH ENCOUNTERS

Introduction: Nursing care is widely recognized to be a vital element in stroke care delivery. However, no publications exam-ining clinical education and optimal workflow practices as predic-tors of acute ischemic stroke care metrics exist. This study aimed to explore the impact of a nurse-led workflow to improve patient care that included telestroke encounters in the emergency department. Methods: A nonrandomized prospective pre-and postinter-vention unit-level feasibility study design was used to explore how implementing nurse-driven acute stroke care affects the efficiency and quality of telestroke encounters in the emergency department. Nurses and providers in the emer-gency department received education/training, and then the Nursing-Driven Acute Ischemic Stroke Care protocol was implemented. Results: There were 180 acute ischemic stroke encounters (40.3%) in the control phase and 267 (59.7%) in the postinter-vention phase with similar demographic characteristics. Comparing the control with intervention times directly affected by the nurse-driven protocol, there was a significant reduction in median door-to-provider times (5 [interquartile range 12] vs 2 [interquartile range 9] minutes, P < .001) and in median door-to-computed tomography scan times (9 [interquartile range 18] vs 5 [interquartile range 11] minutes, P < .001); however, the metrics potentially affected by extraneous variables outside door-to-ready times (21 [interquartile range 24] vs 25 [interquar-tile range 25] minutes, P < .001). Door-to-specialist and door -to-needle times were not significantly different. Discussion: In this sample, implementation of the nurse -driven acute stroke care protocol is associated with improved nurse-sensitive stroke time metrics but did not translate to faster delivery of thrombolytic agents for acute ischemic stroke, emphasizing the importance of well-outlined workflows and standardized stroke code protocols at every point in acute ischemic stroke care.

Automated summary

This study explored the impact of a nurse-led workflow on acute ischemic stroke care. The results showed that implementing the nurse-driven protocol significantly reduced the time patients waited for providers and CT scans, but had limited effects on other time metrics. Additionally, the study emphasized the importance of well-outlined workflows and standardized stroke code protocols in every aspect of acute ischemic stroke care.