Establishing an acute stroke management program at AUBMC Emergency Department :a proposal -

Abstract

Stroke is considered the fourth leading cause of mortality in the United States. According to the American Heart Association and American Stroke Association, many patients diagnosed with ischemic stroke are not receiving thrombolytic therapy within the recommended window of treatment because of delays in the assessment and management by emergency department (ED) personnel. At the American University of Beirut Medical Center (AUBMC), the average time frame from stroke symptoms onset to intravenous recombinant tissue plasminogen activator is beyond the target set by the National Institute for Neurological Disorders and Stroke (NINDS), which is 60 minutes. Consequently, to accelerate assessment and management of “brain attacks” a stroke team is recommended. The aim of the project was to review the literature on emergency management of stroke and propose a new management process based on research evidence. This will ensure that treatment with rt-PA is administered within one hour of patient’s arrival to the ED.The project included a process map of the current management of patients presenting with stroke to AUBMC. A gap analysis was made to identify discrepancies from recommended management guidelines. Then a new process was proposed that involved creation of an adult stroke team and a paging system that is feasible at AUBMC. To improve the care delivered to stroke patients, an accelerated ED admission process along with an acute ischemic stroke order set, rt-PA checklist for inclusion and exclusion criteria, and the National Institutes of Health Stroke Scale are proposed to be followed by the health care team. Plans for implementation and evaluation are also proposed.