Ed pause: A nursing driven approach to improving thrombectomy times

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.