Introduction: Timely intervention for patients with acute ischemic stroke is closely linked to improved outcomes. According to AHA guidelines, endovascular thrombectomy (EVT) is the standard of care for patients with large vessel occlusion stroke. To expedite the transition from ED to an EVT suite, parallel processing is critical. At a large urban academic CSC, an opportunity was identified to bridge the gap between patient arrival and neurointerventional radiology (NIR) team arrival for EVT cases presenting directly to the ED during off hours. The goals of this initiative were streamlining care, enhancing efficiency, and improving key stroke metrics. Methods: A multidisciplinary meeting was held with key stakeholders. Neuro ICU charge nurses were chosen to be the Bridge team members. For off-hour ED EVT cases, the Bridge Team is activated by the incoming NIR team. As the NIR team travels to the hospital, bridge team responsibilities include receiving patients in the NIR suite, and the execution of key tasks vetted by NIR experts. Upon activation, the Bridge Team members would sequentially complete each task and give a hand-off to NIR upon arrival. The primary objective was to reduce both ED arrival-to-groin puncture time and arrival-to-first-pass metrics. Results: The NIR Bridge Team has contributed to a reduction in both arrival-to-groin and arrival-to-first-pass times. Prior to the intervention, nights and weekend direct ED EVT cases had a median arrival-to-groin time of 111 minutes (IQR:99-134, n=60) in 16 months. Since the implementation among Bridge team cases this median was reduced to 80 minutes (IQR: 62.5-110, n=5). Similarly, arrival-to-first-pass times improved, with the median decreasing from 127 mins (IQR: 109-134, n=60) pre-intervention in the same 16 months to 93 minutes (IQR:71.5-127, n=5) post implementation. Additionally, compliance with the arrival-to-first pass time of under 90 minutes significantly increased from 6% (4/60) prior to implementation to 40% (2/5) post implementation. Conclusion: In stroke care, where time-based metrics may impact outcome, preliminary data suggests that patients can be safely managed in the NIR suite by a Bridge Team, resulting in improved workflow and reduced treatment times. Additional data is needed to evaluate long-term trends and improvements in 90-day outcomes. Early analysis indicates measurable improvements in key time metrics, no observed safety concerns, and positive feedback from staff involved.
Schrier et al. (Thu,) studied this question.