Between 5% and 15% of strokes occur in hospitalized patients and are associated with 54% mortality, increased cost of care, and a longer length of stay. Stroke or transient ischemic attack (TIA) patients arriving in the emergency department of a Joint Commission on Accreditation of Healthcare Organizations (JCAHO)‐certified primary stroke centerare evaluated promptly. Asimilar process forevaluating stroke or TIA in a hospitalized patient does not exist in most community hospitals. Brain attack response teams (BARTs) can address this gap.
The goal of the study was to develop a care process to identify and evaluate patients with stroke or strokelike symptoms occurring in hospitalized patients in an urgent manner.
The Swedish Medical Center is a 2‐campus program with a 1082‐bed capacity. Primary Stroke Center certification was obtained from the JCAHO in 2004. Deficiencies were noted in the approach to stroke and TIA symptoms occurring in hospitalized patients when compared to the evaluation provided for patients with similar symptoms arriving in our emergency departments. Adetailed look at the care processes led to amalgamating functions of the stroke team staff, plus hospitalists and an augmented hospital rapid‐response team — protocols, algorithms, and roles were defined, with subsequent training placed on distinguishing stroke patients from mimics. Acute reperfu‐sion therapies were coordinated by the stroke team for qualified patients. The nursing staff was educated about stroke signs and symptoms and was empowered to initiate the BART. This process carries the same level of urgency as a code 199 (for cardiac and respiratory codes), as therapies for reperfusion in acute ischemic stroke are time dependent.
Since its debut in February 2006, this process has been initiated 91 times. The patients in 42 of these were diagnosed as having either a stroke or a TIA. One patient met criteria for reperfusion therapy poststroke. A substantial number of the calls were because of a change in patient mental status, which also received prompt evaluation.
It was challenging to embed a new code system into the hospital care processes. Difficulties ranged from identifying the right set of personnel to staff the response team across 2 campuses to technical issues such as synchronization of pagers. Because most patients with stroke or TIA symptoms are hemodynamically stable, an urgent response required a change in the mind‐set of the responders as well as those initiating the BART. This change was achieved through education as well as providing feedback to the stakeholders.
The value of BART is 3‐fold: demonstrated system ability to assure early recognition, evaluation, and treatment for acute hospitalized strokes; implementation of standard stroke protocols; and assuring stroke mimics receive appropriate urgent medical treatment by a team of trained medical providers.
S. Sachdeva, Boehringer Ingelheim, speakers bureau; S. Schlegel, None; T. Cress, None; W. Likosky, None.
To cite this abstract:Sachdeva S, Schlegel S, Cress T, Likosky W. Brain Attack Response Team (BART) Assures Evaluation and Treatment of Stroke and Stroke Mimics in Hospitalized Patient. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 97. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/brain-attack-response-team-bart-assures-evaluation-and-treatment-of-stroke-and-stroke-mimics-in-hospitalized-patient/. Accessed May 26, 2019.