Nurse-Activated Stroke Codes Improve Process, Clinical Outcomes

A nurse-driven stroke evaluation algorithm improved patient triage and treatment utilization.

VANCOUVER, British Columbia – Nurse-activated stroke codes help improve both process and clinical outcomes in the emergency department, according to results from a retrospective analysis presented at the 2016 annual meeting of the American Academy of Neurology (AAN).

Knowing “time is brain,” Sarah Song, MD, MPH, of Rush University Medical Center, and colleagues sought to improve acute stroke process metrics by transitioning from a typical physician-driven stroke evaluation algorithm to a nurse-driven process in an urban comprehensive stroke center. In order to do so, nursing staff were trained to recognize stroke symptoms, and an alert process initiated by the greet or triage nurse was activated.

Stroke code data from January 1, 2013 through August 16, 2015 were included in the study, with nurse-activated stroke codes initiated on December 6, 2014. Overall, 221 patients were included in the pre- and 103 in the post-intervention analysis.

Following initiation of nurse-activated stroke codes, all process outcomes improved. Overall stroke team paging improved from 57% to 96%, with stroke team paging within 15 minutes of patient arrival improving significantly from 33% to 71%; 45-minute door-to-lab goal improved from 33% to 43%; and 45-minute CT scan order-to-complete goal improved from 94% to 98%. Clinical outcomes, including the percentage of patients receiving intravenous tissue plasminogen activator (tPA) increased from 1% to 4%, and average door-to-endovascular procedure time decreased from 2 hours 43 minutes to 1 hour 56 minutes. No change in door-to-needle times and percentage of patients sent home or to inpatient rehabilitation were observed.

Based on the considerable improvements observed in the study, the authors stress that continual evaluation of triage protocols is necessary to optimize acute stroke treatment.

Click here for more coverage from the 68th Annual Meeting of the American Academy of Neurology, April 15-21, 2016, in Vancouver, British Columbia, Canada.


Song S, Diebolt E, Livesay SL, et al. Nurse-activated acute stroke codes in the emergency setting improves process and clinical outcomes. Presented at: 68th Annual Meeting of the American Academy of Neurology. April 15-21, 2016; Vancouver, British Columbia, Canada. Abstract S16.006.