Implementation of a stroke alert protocol in the emergency department: a pilot study

Area of Science:

• Emergency Medicine
• Neurology
• Healthcare Management

Background:

• Tissue plasminogen activator (tPA) is a critical stroke treatment but has a narrow 3-hour administration window.
• Rapid identification and triage of stroke patients are essential to maximize treatment efficacy and reduce mortality.
• Current emergency department (ED) workflows may delay time-sensitive stroke interventions.

Purpose of the Study:

• To evaluate the impact of a new stroke alert protocol and education program on ED treatment times.
• To determine if the protocol reduces the time from patient arrival to computed tomography (CT) scan and stroke treatment.
• To assess the effect on the administration of tPA within the critical treatment window.

Main Methods:

• Prospective pilot study at Geisinger Medical Center comparing pre- and post-protocol implementation data.
• Formal stroke protocol integrated various hospital departments for rapid patient identification and triage.
• Retrospective analysis of patient records (n=233) from two 1-year periods, including inclusion/exclusion criteria for stroke patients.

Main Results:

• Median CT scan time reduced significantly for patients within 3 hours (65.5 to 54.0 min) and 3-6 hours (94.5 to 48.5 min) of symptom onset.
• Mean time from ED arrival to tPA treatment decreased from 85.5 to 48.9 minutes post-protocol.
• Increased tPA administration observed in the post-protocol year (12/79 patients vs. 4/86 patients).

Conclusions:

• A formal stroke protocol combined with a targeted education program effectively reduces door-to-treatment times for stroke patients.
• The implemented protocol streamlines emergency care, leading to faster diagnostic imaging and treatment initiation.
• This approach demonstrates potential for improving outcomes in acute stroke management.