NASCARENursing-driven Acute Stroke Care

Mark Goldberg, MDUT Southwestern Medical CenterLSS Annual Meeting - November 6, 2015

Julian Yang, MD (now at Duke)

Michelle Provencher, RN, MS◦ LSS and NASCARE Lead Coordinator

Mark Goldberg, MD (PI) DaiWai Olson, RN, PhD Robin Novakovic, MD Steven Figueroa, MD

TBN research coordinator

Investigator Team

The target time for delivery of IV TPA is < 60 min from hospital arrival (door-to-needle time)

Many hospitals do not meet this metric

Average door-to-physician log-on time in telestroke encounters nationwide was 76.3 minutes Ref: Targeting Telestroke: Benchmarking Time Performance in

Telestroke Consultations (Yang et al., 2013)

Background

Acute stroke delivery metrics can be improved by providing ED nurses with:◦An educational platform ◦An organizational tool◦A standardized stroke code protocol based

on core principles inspired by a “pit stop” care model

NAS-Care Hypothesis

1. Identification of shared goals

2. Organized urgency with the removal of gatekeepers

3. Multi-personnel, parallel processing

4. Focus on defined staged roles and tasks

5. Empowered engagement, empowered responsibility

NAS-Care Principles

The nurse is the usually the first person to see the patient

Takes responsibility for t-PA <60 minutes

Provides information needed to make a t-PA decision to physician as quickly as possible

The RN is the DRIVER

Phase 1 – Site Selection and PreparationPhase 2 – Data Collection: Baseline (3 months)Phase 3a – NAS-Care Protocol Implementation

o NIHSS trainingo Site Visit

• Educational Lecture: “Time is Brain/Racing to the Finish”

• Mock Code Drills - “The 30-minute Stroke Code”o NAS-Care Run Sheet Implementation

Phase 3b – Data Collection: NAS-Care (6 months)Phase 4 – Exit Procedures

NASCARE Research Plan

Door-to-Provider (DTP) Door-to-CT (DTCT)

Door-to-Ready (DTR)◦“Ready” signifies acquisition of all data points

needed to make a decision for t-PA

Door-to-Specialist (DTS) Door-to-Needle (DTN)

Key Metrics

NAS-Care started data collection eight months ago

Two hospital in East Texas are currently collecting data

To date, 86 patients have been enrolled

NAS-Care Progress

Three more hospitals in North and West Texas to start data collection in the next year

Partner hospitals of other LSS coordinating centers to start data collection◦ UT Health Science Centers – San Antonio and

Houston have made great progress, and are both IRB approved

◦ Seton Healthcare Family is currently waiting for any proposed changes to be finalized

Reviewing for possible protocol changes for endovascular therapy

Future direction

Thank You