Date of Award

Summer 2022

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Dr. Heather Wallace

Preceptor

Dr. Jitendra Sharma

Mentor

Brittany Stegall

Abstract

Background: Time matters in stroke care, and every second counts because the extent of irreversible neuronal damage increases over time (Saver, 2006). Therefore, the American Stroke Association (ASA) recommends a door to computed tomography time of 20 minutes or less for patients presenting with signs of acute ischemic stroke. This time metric in stroke care is often not met, resulting in the delay of care of patients which translates to poorer outcomes, including death and a decreased quality of life in patients who have suffered an acute ischemic stroke (Kamal, Sheng, et al., 2017).

Purpose: The purpose of this DNP project was to improve stroke care at a rural hospital, by increasing staff awareness of the triage process for ambulatory patients presenting to the emergency department with signs of acute ischemic stroke to achieve door to computed tomography times of 20 minutes or less.

Methods: This practice improvement project consisted of process mapping, optimizing, streamlining stroke triage procedures, and education of staff. The nursing staff were introduced to a streamlined stroke triage process to achieve the ASA recommendation. A visible representation of the triage process was displayed in the triage area of the emergency department to provide a consistent reference for staff.

Results: Door to CT times increased from 29 minutes (n=32) to 35 minutes (n=7).

Conclusion: In opposition to its set out goals, prolonged rather than decreased DTCTs were noted with the likelihood of confounding factors playing a role in the obtained results. The project invigorated quality improvement efforts in stroke care and resulted in identifying several future process improvement ideas.

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