A streamlined, nurse-led response for hospitalized patients experiencing acute stroke at UT Southwestern Medical Center reduced the time from symptom onset to imaging and treatment—factors closely linked to better patient outcomes.
The study, Use of Rapid Response Teams to Expedite Imaging and Treatment for Inpatients With Acute Stroke, examines more than 6 years of data from in-hospital Code Stroke activations at the academic medical center in Dallas.
Study Shows Faster Imaging When Rapid Response Nurses Lead Code Strokes
The analysis revealed that a high percentage of Code Stroke activations were initiated by the rapid response team (RRT). Patients whose codes were driven by RRT nurses underwent critical imaging studies and received confirmed radiology results faster than patients whose activations were not RRT-led.
The research team presented the findings at the American Association of Critical-Care Nurses 2024 National Teaching Institute & Critical Care Exposition, where the study was recognized as an Outstanding Research Abstract.
Co-author Kathrina Siaron, BSN, CCRN, SCRN, assistant unit manager of the Rapid Assessment Team at Parkland Hospital and a member of the UT Southwestern Neuroscience Nursing Research Center, said the results reflect the impact of nursing leadership in time-sensitive stroke care.
“The Code Stroke process is driven by the rapid response team from activation to intervention, leading to a significant decrease overall in inpatient stroke treatment times within our institution,” Siaron said. “Our findings highlight the domino effect of reducing the time from initial symptom recognition to calling the RRT, thereby also shortening the time to Code Stroke activation, imaging, and treatment.”
Updated Protocol Streamlines Nursing-Led Stroke Response
Based on best-practice recommendations from the American Stroke Association, the hospital’s stroke coordinators worked with the RRT to streamline the in-hospital Code Stroke activation protocol in late 2016.
The study analyzed data from January 2017 through March 2023 using an internal database maintained by the hospital’s stroke coordinators.
Under the revised workflow, the patient’s primary nurse is responsible for activating the RRT when a significant change in neurological status is observed. The responding RRT nurse conducts an initial assessment and determines whether to activate an in-hospital Code Stroke.
Once a Code Stroke is activated, key stakeholders are notified through the paging system, and the RRT nurse uses a standardized order set to authorize diagnostic examinations and imaging. This approach minimizes delays to initial imaging and expedites radiology results that inform neurologists’ treatment decisions.
RRT-Driven Codes Deliver Measurable Time Savings
Of the 900 patients who met the inclusion criteria, 836 Code Stroke activations were initiated by the RRT, and 64 were not. Compliance with the updated workflow improved over time, potentially reducing the size of the non–RRT-driven cohort during the six-year study period.
Patients with RRT-initiated Code Strokes reached imaging more quickly, with a mean time of 15.7 minutes from activation to imaging, compared with 23.2 minutes for patients whose codes were not RRT-driven. Radiology results were also returned an average of eight minutes faster—16.7 minutes versus 24.5 minutes.
Findings Highlight the Critical Role of Nurses in Stroke Care
More Code Strokes were activated in intensive care units and cardiovascular units than in other hospital areas, reinforcing the need for strong stroke assessment skills among nurses working in critical care and cardiac progressive care settings.
As a comprehensive stroke center, the institution maintains 24/7 availability of an on-call neurologist, interventional neuroradiologist, and procedural nurse. The study noted slightly longer mean response times among in-house neurologists during RRT-driven activations than during non–RRT-driven activations.
Researchers attributed this difference to workflow nuances. In some cases, bedside staff activated the Code Stroke based on initial neurologist guidance while the physician was en route. In other instances, neurologists activated the Code Stroke at the bedside, resulting in shorter recorded response times.
