Neuro-Alert: Hemorrhagic Stroke Expedited Transfer Process from ED to NCCU

2.50
Hdl Handle:
http://hdl.handle.net/10755/623701
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Neuro-Alert: Hemorrhagic Stroke Expedited Transfer Process from ED to NCCU
Author(s):
Rainey, Kaci
Lead Author STTI Affiliation:
Non-member
Author Details:
Kaci Rainey, MSN, RN, CEN
Abstract:

Poster presentation

Session D presented Friday, September 15, 2017

Purpose: We sought to develop a Neuro-Alert process for non-traumatic intracerebral hemorrhages in an effort to reduce transfer time from emergency department (ED) arrival to Neuro Critical Care Unit (NCCU) and bring the neurocritical care team immediately to the ED bedside.

Design: This project was designed as a performance improvement initiative between the ED and NCCU. This project aimed to decrease ED LOS, improve patient outcomes, increase patient safety and facilitate collaboration and communication across interdisciplinary departments.

Setting: Christiana Care Health System, located in suburban Newark, Delaware, is one of the country's largest health care providers, ranking 22nd in the nation for hospital admissions. Christiana Care is a major teaching hospital with two campuses with more than 1,100 patient beds and a third location with a free-standing ED. The system is home to Delaware's only Level I trauma center and Comprehensive Stroke Center.

Participants/Subjects: The participants were non-traumatic intracerebral hemorrhage patients who presented to Christiana ED and required admission to the NCCU.

Methods: Multiple baseline data points were collected from July 2015 to October 2015 including: mean ED arrival to NCCU arrival (288 minutes) , ED arrival to NCCU consult (148 minutes), NCCU consult to NCCU arrival (174 minutes) and CT Completion time to NCCU arrival (180 minutes).

An interdisciplinary team comprised of ED and NCCU bedside nurses, NCCU attending physician and the stroke program coordinator was developed to streamline the process between the ED and NCCU once the patient has been identified as a hemorraghic stroke. An algorithm was developed outlining the "Neuro-Alert" expedited process and all staff were educated in a timely manner. When a patient was idenfitied as a non-traumatic ICH or SAH, the ED physician would contact the NCCU physcian and activate a "Neuro-Alert". The "Neuro-Alert" activation alerts several key personnel, expedites admission to NCCU, improves communication among ED and NCCU departments, and alerts the NCCU Advanced Practice Nurse to respond to the ED and remain at bedside until patient is successfully transfered from ED to NCCU. The "Neuro-Alert" process went "live" on November 1, 2015.

Results/Outcomes: The same data points were collected from November 2015 to February 2016 following the initiation of the "Neuro-Alert" process. Overall, the mean ED arrival to NCCU arrival decreased by 60 minutes, the ED arrival to NCCU consult decreased by 37 minutes, the NCCU consult to NCCU arrival decreased by 58 minutes and the CT Completion time to NCCU arrival decreased by 44 minutes.

Implications:  The impact of expedited transfer of a critically ill stroke patient from the ED to NCCU in a timely manner is paramount to improved patient outcomes. A study by Rincon et al (2010) shows that an ED LOS greater than 5 hours before transfer to the NCCU is independently associated with four times the increase of poor patient outcomes at hospital discharge. Many factors contribute to prolonged ED LOS and serve as barriers to expediting stroke patients to the NCCU. This project advocates for the hemorraghic stroke patient by matching their needs with immediate management by the Neurocritical Care team.

Keywords:
Stroke Treatment; Performance Improvement; Emergency Department
Repository Posting Date:
5-Dec-2017
Date of Publication:
5-Dec-2017
Conference Date:
2017
Conference Name:
Emergency Nursing 2017
Conference Host:
Emergency Nurses Association
Conference Location:
St. Louis, Missouri, USA
Description:
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleNeuro-Alert: Hemorrhagic Stroke Expedited Transfer Process from ED to NCCUen_US
dc.contributor.authorRainey, Kacien
dc.contributor.departmentNon-memberen
dc.author.detailsKaci Rainey, MSN, RN, CENen
dc.identifier.urihttp://hdl.handle.net/10755/623701-
dc.description.abstract<p>Poster presentation</p> <p>Session D presented Friday, September 15, 2017</p> <p>Purpose: We sought to develop a Neuro-Alert process for non-traumatic intracerebral hemorrhages in an effort to reduce transfer time from emergency department (ED) arrival to Neuro Critical Care Unit (NCCU) and bring the neurocritical care team immediately to the ED bedside.</p> <p>Design: This project was designed as a performance improvement initiative between the ED and NCCU. This project aimed to decrease ED LOS, improve patient outcomes, increase patient safety and facilitate collaboration and communication across interdisciplinary departments.</p> <p>Setting: Christiana Care Health System, located in suburban Newark, Delaware, is one of the country's largest health care providers, ranking 22nd in the nation for hospital admissions. Christiana Care is a major teaching hospital with two campuses with more than 1,100 patient beds and a third location with a free-standing ED. The system is home to Delaware's only Level I trauma center and Comprehensive Stroke Center.</p> <p>Participants/Subjects: The participants were non-traumatic intracerebral hemorrhage patients who presented to Christiana ED and required admission to the NCCU.</p> <p>Methods: Multiple baseline data points were collected from July 2015 to October 2015 including: mean ED arrival to NCCU arrival (288 minutes) , ED arrival to NCCU consult (148 minutes), NCCU consult to NCCU arrival (174 minutes) and CT Completion time to NCCU arrival (180 minutes).</p> <p>An interdisciplinary team comprised of ED and NCCU bedside nurses, NCCU attending physician and the stroke program coordinator was developed to streamline the process between the ED and NCCU once the patient has been identified as a hemorraghic stroke. An algorithm was developed outlining the "Neuro-Alert" expedited process and all staff were educated in a timely manner. When a patient was idenfitied as a non-traumatic ICH or SAH, the ED physician would contact the NCCU physcian and activate a "Neuro-Alert". The "Neuro-Alert" activation alerts several key personnel, expedites admission to NCCU, improves communication among ED and NCCU departments, and alerts the NCCU Advanced Practice Nurse to respond to the ED and remain at bedside until patient is successfully transfered from ED to NCCU. The "Neuro-Alert" process went "live" on November 1, 2015.</p> <p>Results/Outcomes: The same data points were collected from November 2015 to February 2016 following the initiation of the "Neuro-Alert" process. Overall, the mean ED arrival to NCCU arrival decreased by 60 minutes, the ED arrival to NCCU consult decreased by 37 minutes, the NCCU consult to NCCU arrival decreased by 58 minutes and the CT Completion time to NCCU arrival decreased by 44 minutes.</p> <p>Implications:&nbsp; The impact of expedited transfer of a critically ill stroke patient from the ED to NCCU in a timely manner is paramount to improved patient outcomes. A study by Rincon et al (2010) shows that an ED LOS greater than 5 hours before transfer to the NCCU is independently associated with four times the increase of poor patient outcomes at hospital discharge. Many factors contribute to prolonged ED LOS and serve as barriers to expediting stroke patients to the NCCU. This project advocates for the hemorraghic stroke patient by matching their needs with immediate management by the Neurocritical Care team.</p>en
dc.subjectStroke Treatmenten
dc.subjectPerformance Improvementen
dc.subjectEmergency Departmenten
dc.date.available2017-12-05T21:31:11Z-
dc.date.issued2017-12-05-
dc.date.accessioned2017-12-05T21:31:11Z-
dc.conference.date2017en
dc.conference.nameEmergency Nursing 2017en
dc.conference.hostEmergency Nurses Associationen
dc.conference.locationSt. Louis, Missouri, USAen
dc.descriptionENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missourien
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