1. Stroke Alert at Lutheran General Hospital, Park Ridge, IL
Lynn Michel, RN, MSN, APN / CNS

2. Stroke Alert Stroke Alert started on 01/01/07
700 bed suburban teaching hospital
Level I Trauma Center

3. Pre-Stroke Alert Emergency room Patient triaged as priority 3 or 4 / 5
CT ordered along with other “stat” ER orders
In-House patients
Physician notified of patients change in condition
CT if ordered was ordered “stat”
Neurology consult if ordered

4. Why do a Stroke Alert?
As a Primary Stroke Center we wanted to have a process in place to:
Expedite the assessment and treatment of patients experiencing stroke symptoms.
To decrease the “Door to CT time” to 25 minutes or less for ER and inpatients experiencing stroke symptoms less than 3 hours in duration

5. Why is a Stroke Alert important?
tPA can reverse an Acute Ischemic Stroke but must be given within 3 hours of symptom onset
Interventional procedures now available
Hemorrhagic stroke is also an emergency and may require surgical intervention.

6. Hemorrhagic Stroke
10-15% of all strokes… 37,000 to 52,400 new cases / year
Incidence: 15 per 100,000 individuals / year
Rate expected to double by 2050
African-American and Japanese: incidence is twofold than in Caucasians
35 to 52% 1 month mortality
Only 20% were living independently by 6 months

7. The beginning….6 months prior to starting
Stroke Coordinator
Stroke Team Neurologist
ED Medical Director
Critical care director
Hospital Operator

8. Stroke Alert Based on the “Code Yellow” and “Cath Lab Alert”
We chose to call it “Stroke Alert” and not another “coded name”
This increases awareness to staff and lay people that stroke is an emergency

9. What we needed:
Provide rapid diagnosis and treatment of stroke. (RRT for inpatients)
Written protocols (time frame) for assessment and treatment. (RRT)
CT to get a scanner prepared
tPA if appropriate (tPA on call list)
Neuro-Surgery if appropriate

10. Nursing Considerations
Call x and report that you have a “Stroke Alert”
The operator will page
“Stroke Alert…and unit name”
or “Stroke Alert…ER”
RRT will be paged and respond to in-house strokes

11. Nursing considerations
CT department will get a CT scanner ready for the patient.
Nurse can call RRT first who then will assess and call the “Stroke Alert”

12. Stroke Alert 1 year later

13. How many? 196 stroke alerts in 2007 1st quarter of 2007 5753

14. Where do the Stroke Alerts Happen at LGH?

16. Inpatients CT times

17. Door to CT times for ER patients

18. The use of tPA increased by 64% in the ER

19. Lessons learned Pharmacy became involved to start the tPA checklist
There was “over calling” in the beginning
Need to orient new personnel
Need to change time criteria to reflect IA tPA and research study time frames

20. Barriers 1 year out MYTHS:
Physicians and nurses believe that Stroke Alert is only for those patients who qualify for tPA
TRUTH
10-15% of all strokes are hemorrhagic which also need emergency treatment
LGH has a stroke research project for ischemic stroke patients who don’t qualify for tPA

21. Questions?