ABSTRACT
Introduction: The current Joint Commission recommendation for door to skin puncture is less than 60 minutes for transfer cases. It is imperative that no time is lost in moving these patients safely through the Emergency Department (ED) to the Interventional Radiology (IR) Suite. The goal of this study was to assess if a rapid, 11-step nursing driven checklist could decrease time spent in the ED and subsequently improve our thrombectomy times in transfer patients. Methods: We developed the following 11 steps: (1) ED staff is notified of incoming ED Pause transfer. (2) ED receives report from sending facility RN. (3) Register the patient upon arrival.(4) Activate EMS Stroke alert. (5) Verify patient's identity using two patient identifiers, apply wristband. (6) Vital signs (to ensure no decompensation en route), connect patient to the transport monitor. (7) Chart weight in the system. (8) Confirm two working IVs. (9) Confirm negative Covid test or send a rapid if a negative Covid test cannot be confirmed. (10) Ensure the patient is undressed and ready to go to IR. (11) Confirm the 'admit to inpatient' order is placed. ED staff were educated and checklists were posted in the ambulance bay and nurses' station. Data were reviewed pre- (April 2019 to March 2020) and post- (April 2020 to March2021) implementation to assess the percentage of patients captured by the tool and its impaction thrombectomy times. Data were analyzed using a t-test. Results: There were 25 patients transferred in the post vs 16 in the pre-implementation group. The median door to skin puncture (DTS) (post: 37 mins {IQR 31-43} vs. pre: 50 mins {IQR 47- 71}p=0.045), door to device deployed (post: 52 mins {IQR 45-65} vs. pre: 70 mins {IQR 65- 94}p=0.037), and door to recanalization (post: 71 mins {IQR 54-102} vs. pre: 99 mins {IQR 70- 118}p=0.043) times decreased in the post implementation group. Conclusion: A nursing driven ED checklist is a successful tool in decreasing thrombectomy times in transfer patients.
ABSTRACT
Introduction: The COVID-19 pandemic presents obstacles to time sensitive emergencies, such as stroke care. In acute strokes, knowing the COVID-19 status may help to preserve personal protective equipment (PPE) in patients in whom a thrombectomy may be indicated and helps to decrease unnecessary exposure. This study aims to demonstrate that rapid evaluation of a patient's COVID-19 status is feasible without delaying treatment times. Methods: An intradisciplinary team was convened to create a workflow for rapid COVID-19 testing. The Abbott Rapid® COVID-19 swab kit and assay were stocked in the ED Pyxis, utilizing the narcotic count feature to ensure all swabs were accounted. Upon activation of Code Stroke, the ED RN donned PPE and swabbed the patient's naso-oral pharynx. The collected swab was labeled, placed in a bio-hazard bag, sanitized and handed to a second RN outside of the room. The specimen was taken to a pre-alerted lab technician who prepped the assay after hearing the code stroke. After specimen collection, the patient followed the normal code stroke pathway and was taken to the CT scanner. Metrics were analyzed for the pre COVID-19 (January through April) and during active COVID-19 (May through July) periods. Results: There were 136 code strokes from January thru July 2020. 81 were during pre-COVID vs. 55 during active-COVID. 47 of 55 (96%) were swabbed, 2 (4%) of whom were positive. There was no difference between pre-COVID and active-COVID door to CT initiated time (16 mins [IQR 13-24] vs. 22 mins [IQR 13-25] p=0.75), door to CT resulted time (21 mins [IQR 15-26]) vs. 23 mins [IQR 16-29] p=0.63). 18 patients received tPA pre-COVID and 5 during active-COVID with no difference in DTN (pre: 37.5 mins [IQR 30-43] vs. active: 28 mins {IQR 26-41] p=0.37). Door to CT initiated was faster for those who had their COVID swab performed pre-CT (14 mins [IQR 11.5-16.5] p=0.034) vs. post-CT (20 mins [IQR 17-28]). Likewise, door to CT resulted was also faster pre-CT: 24 mins [IQR 19-32] vs. post-CT: 17 mins [IQR 15-23] (p=0.04). Conclusion: The COVID-19 rapid swab code stroke process was feasible and did not delay treatment times.