Improving stroke care delivery for in-hospital stroke alerts by addition of overhead “code stroke” announcements: Single comprehensive stroke center\u27s experience

Introduction: In-hospital strokes account for 2-17% of all stroke patients. Mobilization of resources for in-hospital strokes is challenging and it takes longer to complete the necessary evaluations as compared to those presenting to the emergency room. Dedicated “stroke code teams” for in-hospital stroke patients have been shown to improve the adherence to the AHA\u27s get with the guidelines (GWTG) initiative but there is a paucity of research analyzing this process. Aim: To assess whether the addition of an overhead “code stroke” announcement to an existing group paging system for inhospital strokes decreases the time required for obtaining the necessary evaluations. Methods: An overhead “code stroke” announcement and process education was introduced at our hospital in addition to the existing stroke group paging system. We analyzed prospectively collected time based measures for in-hospital stroke code activations 4 months before and after implementation. Wilcoxon two-sample test was used to analyze the relevant time variables between the two groups. Results: The post-stroke group had significantly shorter times from stroke alert to CT and CTA interpretation, time from symptom onset to CT and CTA interpretation, and time for CT and CTA interpretation when compared to the pre-stroke alert group (see table). The post-stroke alert period captured significantly more acute strokes than the pre-stroke alert period (6.25 vs 1.75 per month, p=0.001 from binomial test). Conclusion: The addition of an overhead “code stroke” along with process education can drastically reduce important GWTG\u27s acute stroke evaluation times at a comprehensive stroke center. We suggest that improved coordination between the services, along with the urgency associated with an overhead “code stroke”, led to improvement in the evaluation times. We also noted an increase in the number of stroke-code activations, probably due to increased perception and awareness of stroke as a true emergency. (Table Presented)