title: Feasibility and Efficacy of Nurse-Driven Acute Stroke Care.
abstract: BACKGROUND
  Acute stroke care requires rapid assessment and intervention. Replacing traditional sequential algorithms in stroke care with parallel processing using telestroke consultation could be useful in the management of acute stroke patients. The purpose of this study was to assess the feasibility of a nurse-driven acute stroke protocol using a parallel processing model.
  
  
  METHODS
  This is a prospective, nonrandomized, feasibility study of a quality improvement initiative. Stroke team members had a 1-month training phase, and then the protocol was implemented for 6 months and data were collected on a "run-sheet." The primary outcome of this study was to determine if a nurse-driven acute stroke protocol is feasible and assists in decreasing door to needle (intravenous tissue plasminogen activator [IV-tPA]) times.
  
  
  RESULTS
  Of the 153 stroke patients seen during the protocol implementation phase, 57 were designated as "level 1" (symptom onset <4.5 hours) strokes requiring acute stroke management. Among these strokes, 78% were nurse-driven, and 75% of the telestroke encounters were also nurse-driven. The average door to computerized tomography time was significantly reduced in nurse-driven codes (38.9 minutes versus 24.4 minutes; P < .04).
  
  
  CONCLUSIONS
  The use of a nurse-driven protocol is feasible and effective. When used in conjunction with a telestroke specialist, it may be of value in improving patient outcomes by decreasing the time for door to decision for IV-tPA.
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas.
authors.forename: Shraddha
authors.initials: S
authors.lastname: Mainali
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas.
authors.forename: Sonja
authors.initials: S
authors.lastname: Stutzman
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas.
authors.forename: Samarpita
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas.
authors.forename: Amanda
authors.initials: A
authors.lastname: Dirickson
authors.affiliation: Hospital Accreditation Services, American Heart Association, Dallas, Texas.
authors.forename: Laura
authors.initials: L
authors.lastname: Riise
authors.affiliation: Department of Nursing, Emergency Department, University of Texas Southwestern, Dallas, Texas.
authors.forename: Donald
authors.initials: D
authors.lastname: Jones
authors.affiliation: Department of Neurology, Duke University, Durham, North Carolina.
authors.forename: Julian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas. Electronic address: daiwai.olson@utsouthwestern.edu.
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
mesh_terms: D019091:Critical Pathways; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D024802:Nurse's Role; D009741:Nursing Staff, Hospital; D010348:Patient Care Team; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000451:nursing*; D019112:Teleradiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Nursing; acute ischemic stroke; door to needle; systems of care