NAS-Care is a quality improvement Lone Star Stroke (LSS) study that aims to determine the effect of nursing-driven stroke protocols in telestroke hospitals. The goal of NAS-Care is to empower emergency department (ED) nurses to be engaged leaders in the stroke code process. Part of this empowerment involves the nursing staff activating stroke codes, performing standing orders, and working in parallel to quickly and efficiently accomplish a common goal – to gather all information needed to make a tP-A decision as quickly as possible.
This ongoing study will engage up to 25 LSS partner institutions to collect up to 800 patient cases. During the intervention phase of this trial, we implement a specific protocol designed to empower bedside nurses to rapidly gather the data needed for a provider to make a decision regarding t-PA administration. Each case in this phase is mediated via the “NAS-Care Run Sheet,” a detailed reference that serves as a data collection tool and a workflow template during actual patient encounters. Each case in this study reflects a stroke code activation, and the primary outcome variables reflect time metrics related to these stroke codes.
Door-To-Ready (DTR) is a unique time metric to telestroke clinical encounters and reflects the earliest time point at which all of the necessary data for a tele-specialist or ED Provider to make a decision regarding t-PA treatment has been collected. The NAS-Care hypothesis is that the implementation of this protocol will significantly improve the efficiency and quality of telestroke encounters, as demonstrated by a decrease in DTR.
Currently, eight hospitals have completed the NAS-Care study with a combined total of 484 patient cases. An interim analysis will be performed to determine if more data is needed to reach a conclusion. We hope that the results of this study will help to establish a standard protocol for all telestroke encounters throughout the state of Texas. If it is determined that the protocol implemented during the NAS-Care intervention phase results in a decreased DTR, it will be valuable for telestroke hospitals to adopt this process. For those hospitals that do not show improvement following the NAS-Care protocol, we will examine the processes that were already in place for stroke code activations to determine if they are more effective than the NAS-Care protocol. Overall, the potential impact of this study is the establishment of a standardized telestroke protocol to increase the efficiency and quality of stroke care delivered in telestroke encounters.
Publications
Provencher M, Novakovic R, Figueroa SA, Goldberg M. Nursing-driven Acute Stroke Care (NAS-Care): a Texas State-wide Study of Telestroke. Poster Presentation at: 2018 International Stroke Conference; 2018 Jan 25; Los Angeles, CA.
Provencher M, Goldberg M, Figueroa SA. The Effect of Standardized Stroke Education on the Rate of False-Positive Stroke Code Activations in Emergency Departments Utilizing Telemedicine. Poster Presented at: 2017 Neurocritical Care Society; 2017 Oct 10-13; Waikoloa, HI
