Rapid-Response Teams Can Decrease Admission Times for Patients With Stroke

LOS ANGELES—Adding a rapid-response team member into the emergency department process to coordinate care for patients eligible for IV t-PA significantly reduces door-to-admission times, according to research presented at the International Stroke Conference 2018. This improvement may be attributed to faster placement and prioritized processing of admission orders.

In this study, the rapid-response team “acted as a control center, relaying vital information to the admission office and the acute stroke unit charge nurse,” said Tarun Girotra, MD, a neurologist at the Henry Ford Hospital in Detroit, and colleagues. “The emergency department registered nurse (RN) was relieved of some of the administrative responsibilities and was able to focus solely on patient care, which resulted in decreased misses in the vital sign documentations.”

The American Heart Association (AHA) recommends a door-to-admission time of less than three hours for patients eligible for IV t-PA. In large tertiary hospitals, administrative complexity and the coordination required often cause delays in admissions, said the researchers. Few studies have examined methods for streamlining the process of admitting patients for treatment with IV t-PA and for increasing compliance with the AHA Get With the Guidelines initiative’s quality measures.

Examining a Policy’s Effect on Time to Admission

Dr. Girotra and colleagues conducted a study to assess whether having a dedicated rapid-response team RN available to respond to the emergency department to coordinate care of patients receiving IV t-PA reduces door-to-admission times. A rapid-response team comprises nurses trained for intensive care units who coordinate care within hospitals and actively participate in inpatient emergencies that require resuscitation.

For this study, the emergency department at the authors’ hospital implemented a policy of notifying the rapid-response team RN of all patients eligible for IV t-PA. The role of the rapid-response team was defined as facilitating admissions through the coordination of care between neurology residents, emergency department physicians, the emergency department RN, the stroke unit charge RN, and the admissions office.

The study’s primary end point was door-to-admission times, which were collected prospectively for three months before and after the intervention (ie, the new policy). Secondary end points included the number of missed neurologic checks and vital sign checks, which AHA guidelines recommend recording. Researchers used the Wilcoxon two-sample test to analyze time variables and compliance rates.

Policy Did Not Affect Neurologic Checks

In all, 13 patients were admitted to receive IV t-PA before the intervention, and 16 were admitted after the intervention. Thirty-eight percent of patients in the preintervention group were female, and 56% of patients in the postintervention group were female. The mean age of participants in the preintervention group was 62.7, and the mean age of participants in the postintervention group was 67. The study lasted six months, with three months of preintervention and three months of postintervention.

Overall, the intervention decreased the mean door-to-admission time from 242.7 minutes to 167.9 minutes. In addition, significantly fewer patients had more than one miss in their documented vital signs after the intervention, compared with before the intervention. No significant difference was observed in the documented neurologic checks per the AHA protocol. There was a higher-than-expected number of misses in neurologic exams by the emergency department RN, however, said the authors. Other centers could use similar interventions to help decrease door-to-admission times, the investigators concluded.

—Erica Tricarico