Concerns were voiced by TeleSpecialists’ Quality Program Specialist, Haley Fogle, RN, that alteplase administration times were not consistent, often delayed beyond the 45-minute or less goal. Fogle worked collaboratively with Kevin Rodman, AdventHealth Gordon’s Emergency Director, to identify areas of delay during the stroke alert process. Two major issues were found: pre-arrival notifications to TeleSpecialists were not being executed, and process delays were slowing down during stroke alerts.
In the initial review, it was identified that EMS pre-arrival notifications were not being called into TeleSpecialists. Immediately, education was provided on the benefits of calling a stroke alert into TeleSpecialists after EMS incoming notifications. This allows the TeleSpecialists TeleNeurologist to be on camera, at bedside, when the
patient arrives at the facility, and accessing them critical information from EMS to expedite patient care.
After a comprehensive review of the hospital’s stroke alert process, the decision was made to overhaul the stroke alert process completely. Best practices were recommended by TeleSpecialists and implemented.
The changes included:
- Patients are triaged and assessed via the TeleSpecialists Pit Stop Program™ (TSPSP) when they arrive at the hospital
- Patients are taken straight to CT after the TSPSP, cutting back on rooming delays
- The creation of a Stroke Kit containing alteplase and blood pressure medications were implemented to ensure quick access and availability
- The telestroke cart is moved to CT to ensure that the Neurologist can quickly assess and make decisions on treatment
Once best practice implementations were started, the average door-to-needle time (DTN) average dropped by 21.5%, down to 32 minutes (including outliers).