2.50
Hdl Handle:
http://hdl.handle.net/10755/324167
Category:
Abstract
Type:
Presentation
Title:
Brain Attack Team to the Brain Attack Room
Author(s):
Marks, Timothy D.; Bilotta, Mary
Author Details:
Timothy D. Marks, MSN, RN, CEN, email: timothy.marks@readinghealth.org; Mary Bilotta, BSN, RN, CEN
Abstract:
Evidence-based Practice Abstract Purpose: Reducing time in administering tissue plasminogen activator (t-PA) for patients that meet criteria during an ischemic stroke, referred to here as a Brain Attack, is critical to enhanced outcomes, and expedites safe, quality care. To reduce this “door to needle” time, a multidisciplinary team of organizational stakeholders was formed and barriers were identified in the current Emergency Department (ED) Brain Attack process. This core group of stakeholders provides a complete complement of personnel throughout continuum of care for patients and family members while in the Emergency Department. Design: A rapid cycle improvement process (PI) was initiated. This PI project included pre-hospital education provided by Emergency Department physicians. The ED physician educators traveled to 35 individual Emergency Medical Services (EMS) stations and provided education. The ED implementations included staff education, purchase of two new stretcher scales, two portable cardiac monitors, and enhancement to the touchscreen emergency activation device. Retrospective chart review was completed monthly on all patients meeting inclusion criteria. Setting: 750 bed not-for-profit, community teaching hospital’s Emergency Department evaluating over 134,000 patients annually. Participants/Subjects: Patient inclusion criteria are over the age of 18 and have a chief complaint of stroke or stroke like symptoms arriving via EMS or by walk-in. Methods: Touchscreen paging allows notification to appropriate departments and personnel within the organization alerting impending patients’ arrival. Upon activation, the Brain Attack Team, comprised of a dedicated ED RN, ED Physician, ED Medic, Registrar and Laboratory Technician respond directly to their designated positions in the ED CT scan anteroom retrofitted for quick assessment of stroke patients. A team approach, committed to patient centered care, is focused to direct EMS crews directly to the Brain Attack Room (BAR). This includes obtaining actual weight (via stretcher scale), initial POC glucose and anticoagulation testing, labs, vital signs, application of cardiac monitor, order placement, and dual NIH stroke scale between ED Physician and ED RN. A streamlined algorithm allows various team members to perform duties simultaneously. This allows patient care to advance quickly and safely into CT scanner for non-contrast CT scan as defined by common stroke protocols. Results/Outcomes: Throughout a nine month (October 2012-June 2013) implementation period, the team saw a median time decrease of 17 minutes to 18 minutes in arrival to CT scan completion, and a decrease of eleven minutes in CT reading time of 47 to 36 minutes. For eligible patients, these two improvements lead to an 87.5% < 3 hours arrival to t-PA with 62.5% of those being under 60 minutes from arrival, the fastest of which was a door to needle in 35 minutes. Implications: Early administration of intravenous thrombolytic therapy has shown to improve neurologic outcomes within the first three months of discharge. These interventions streamline care, thus decreasing the time to definitive care. A positive aspect of implementation has also shown to improve team collaboration and communication for patient centric, quality care delivery.
Keywords:
Reducing time to t-PA; Ischemic Stroke
Repository Posting Date:
4-Aug-2014
Date of Publication:
4-Aug-2014
Conference Date:
2014
Conference Name:
2014 ENA Leadership Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Phoenix, Arizona USA
Description:
2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleBrain Attack Team to the Brain Attack Roomen_GB
dc.contributor.authorMarks, Timothy D.en_GB
dc.contributor.authorBilotta, Maryen_GB
dc.author.detailsTimothy D. Marks, MSN, RN, CEN, email: timothy.marks@readinghealth.org; Mary Bilotta, BSN, RN, CENen_GB
dc.identifier.urihttp://hdl.handle.net/10755/324167-
dc.description.abstractEvidence-based Practice Abstract Purpose: Reducing time in administering tissue plasminogen activator (t-PA) for patients that meet criteria during an ischemic stroke, referred to here as a Brain Attack, is critical to enhanced outcomes, and expedites safe, quality care. To reduce this “door to needle” time, a multidisciplinary team of organizational stakeholders was formed and barriers were identified in the current Emergency Department (ED) Brain Attack process. This core group of stakeholders provides a complete complement of personnel throughout continuum of care for patients and family members while in the Emergency Department. Design: A rapid cycle improvement process (PI) was initiated. This PI project included pre-hospital education provided by Emergency Department physicians. The ED physician educators traveled to 35 individual Emergency Medical Services (EMS) stations and provided education. The ED implementations included staff education, purchase of two new stretcher scales, two portable cardiac monitors, and enhancement to the touchscreen emergency activation device. Retrospective chart review was completed monthly on all patients meeting inclusion criteria. Setting: 750 bed not-for-profit, community teaching hospital’s Emergency Department evaluating over 134,000 patients annually. Participants/Subjects: Patient inclusion criteria are over the age of 18 and have a chief complaint of stroke or stroke like symptoms arriving via EMS or by walk-in. Methods: Touchscreen paging allows notification to appropriate departments and personnel within the organization alerting impending patients’ arrival. Upon activation, the Brain Attack Team, comprised of a dedicated ED RN, ED Physician, ED Medic, Registrar and Laboratory Technician respond directly to their designated positions in the ED CT scan anteroom retrofitted for quick assessment of stroke patients. A team approach, committed to patient centered care, is focused to direct EMS crews directly to the Brain Attack Room (BAR). This includes obtaining actual weight (via stretcher scale), initial POC glucose and anticoagulation testing, labs, vital signs, application of cardiac monitor, order placement, and dual NIH stroke scale between ED Physician and ED RN. A streamlined algorithm allows various team members to perform duties simultaneously. This allows patient care to advance quickly and safely into CT scanner for non-contrast CT scan as defined by common stroke protocols. Results/Outcomes: Throughout a nine month (October 2012-June 2013) implementation period, the team saw a median time decrease of 17 minutes to 18 minutes in arrival to CT scan completion, and a decrease of eleven minutes in CT reading time of 47 to 36 minutes. For eligible patients, these two improvements lead to an 87.5% < 3 hours arrival to t-PA with 62.5% of those being under 60 minutes from arrival, the fastest of which was a door to needle in 35 minutes. Implications: Early administration of intravenous thrombolytic therapy has shown to improve neurologic outcomes within the first three months of discharge. These interventions streamline care, thus decreasing the time to definitive care. A positive aspect of implementation has also shown to improve team collaboration and communication for patient centric, quality care delivery.en_GB
dc.subjectReducing time to t-PAen_GB
dc.subjectIschemic Strokeen_GB
dc.date.available2014-08-04T13:28:43Z-
dc.date.issued2014-08-04-
dc.date.accessioned2014-08-04T13:28:43Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Leadership Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationPhoenix, Arizona USAen_GB
dc.description2014 ENA Leadership Conference Theme: Safe Practice, Safe Care. Held at the Phoenix Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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