Implementation of a Stroke Protocol for Emergency Evaluation and Disposition
University of Chicago
Summary
Most stroke patients are initially evaluated at the closest hospital but some need to be transferred to a hospital that can provide more advanced care. The "Door-In-Door-Out" (DIDO) process at the first hospital can take time making transferred patients no longer able to get the advanced treatments. This study will help hospitals across the US "stand up" new ways to evaluate stroke patients, decide who needs to be transferred, and transfer them quickly for advanced treatment.
Description
Nearly 800,000 people in the United States (US) each year experience acute stroke, which remains the leading cause of adult disability and 5th leading cause of death. Despite the proliferation of stroke centers nationwide, almost half of the US population lives beyond a 60-minute drive of a comprehensive stroke center (CSC) and many patients require inter-hospital transfer (IHT) from a non-CSC to a CSC. Building upon prior work to reduce door-in-door-out (DIDO) time at referring hospitals, this proposal entitled "Hospital Implementation of a Stroke Protocol for Emergency Evaluation and Disposi…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Age \>=18 years * Final diagnosis: AIS, ICH, or SAH Exclusion Criteria: * Final diagnosis: TIA or stroke NOS * Age \<18 years * Comfort care measures on day 0 or 1 * Left hospital against medical advice * Enrolled in clinical trial related to stroke that is competing with this study
Interventions
- BehavioralHI-SPEED Protocol
The HI-SPEED Protocol or Bundle consists of 7 components including 1) stroke screening scales, 2) imaging pathways, 3) telestroke operations, 4) a best practice alert, 5) stroke team communication tool, 6) door-to-needle (thrombolysis) treatment pathway, and 7) a standardized hand-off tool. This protocol will be implemented at each participating health system in clusters of 2 health systems.
Locations (7)
- Yale New Haven HospitalNew Haven, Connecticut
- Jackson Memorial HospitalMiami, Florida
- Emory University HospitalAtlanta, Georgia
- UChicago Medicine Ingalls Memorial HospitalChicago, Illinois
- New York Presbyterian - Weill Cornell HospitalNew York, New York
- University of Cincinnati Medical CenterCincinnati, Ohio