Nurses Are as Specific and Are Earlier in Calling In-Hospital Stroke Alerts Compared to Physicians.
BACKGROUND
In-hospital stroke alerts are typically activated by nurses or physicians when a patient's neurological status acutely changes from baseline. It is unclear if knowledge of stroke symptoms translates to accurate activation of the acute stroke team. We hypothesized that nurses who activate the stroke alert system would correctly identify as great a proportion of acute strokes as physicians. We also investigated the time to activation of these in-hospital stroke alerts.


METHODS
We retrospectively reviewed consecutive inpatient stroke team calls over a 12-month period at a single, tertiary care center. Calls and exact times were identified from the acute stroke pager log. The type of provider who called the stroke alert, patient characteristics, last known well time, and acute stroke symptoms was prospectively collected and retrospectively verified through electronic medical record review. Patients with definite stroke then were retrospectively identified by World Health Organization Monitoring of Trends and Determinants in Cardiovascular Disease (WHO MONICA) criterion.


RESULTS
A total of 93 calls were analyzed. Nurses and physicians/midlevel providers activated the in-hospital stroke alert with a similar percentage of correct stroke diagnosis (62.7% versus 58.8%, P = .82). Nurses activated stroke alerts significantly earlier than physicians/midlevel providers (median 2 hours [IQR .5-6 hours] versus 4.9 hours [IQR 1.3-21.3 hours], P = .0096) from last known well time.


CONCLUSIONS
Nurses identify in-hospital ischemic events with a similar percentage as physicians, and they activate the stroke alerts significantly earlier. The median nursing activation time fell within a 3-hour window for potential systemic thrombolytic or early endovascular therapy. An intensive, focused, collaborative education of nursing staff may further improve inpatient stroke outcomes.
Department of Neurology, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio. Electronic address: georgep@ccf.org.
Pravin
P
George
Department of Neurology, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
Dolora R
DR
Wisco
Akron General Hospital, Akron, Ohio.
James
J
Gebel
Department of Neurology, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
Ken
K
Uchino
Department of Neurology, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio; Department of Neurology, University of Missouri, Columbia, Missouri.
Christopher R
CR
Newey
D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D019091:Critical Pathways; D042241:Early Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D020445:Hospitalists; D006801:Humans; D008297:Male; D009741:Nursing Staff, Hospital; D010348:Patient Care Team; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D013997:Time Factors; D061665:Time-to-Treatment
In-hospital stroke; epidemiology; inpatient; nursing; stroke management