ED revamps stroke care to get rapid CTs and treatment

Door-to-drug times shortened

ED nurses at Mount Desert Island Hospital in Bar Harbor, ME, have dramatically shortened door-to-CT and door-to-drug times with a Code Stroke program, reports Sean Hall, RN, one of the hospital’s ED nurses.

"This has led to just amazing results in patient outcomes," says Hall. "If a small critical access hospital in the middle of one of the nation’s busiest national parks, with over 100 cruise ship visits in six months, can do this with great success, so can other hospitals."

Some ED nurses previously thought that it wasn’t possible to get a stroke patient assessed, prepared, and down to CT scan within the time window for treatment, says Hall, but this is no longer the case.

Nurses coordinate care throughout the entire ED to make this happen, says Hall. Here are the steps that occur in the ED when a Code Stroke is called by emergency medical services (EMS):

  • EMS calls from the scene, after performing the initial examination, to advise the ED that a possible stroke patient is on the way.
  • One ED nurse is designated to handle the incoming stroke patient, and hands off her other patients. "This frees up one nurse, so there is no gap in care for patients currently in the department," Hall explains.
  • The ED physician is alerted to the patient’s expected time of arrival, and is at the door when the patient enters the ED.
  • CT scan is also alerted to the patient’s time of arrival, so they can clear the scanner and be ready for an emergency CT with the radiologist waiting to read the scan.
  • EMS radios the results of blood glucose, oxygen saturation, and the EKG.
  • The nurse and provider greet EMS at the door, and determine whether the patient is stable enough to go to CT. If so, the patient is placed on a monitor while transported to the CT scanner.

"This leads to a rapid CT, rapid read, and short drug-to-door time," says Hall. "We are now trying to shave single minutes off our door-to-CT times. The whole staff finds this a point of personal pride."

Educate everyone

Physicians, nurses, CT technicians, certified nursing assistants, registration, and clerks all coordinate their efforts to prompt quality care, and have gotten dramatic results, says Hall. "This results in saving brain, making what could be a poor quality of life as a result of a cerebrovascular accident into a continued high quality of life," says Hall.

ED nurses draw on their patient education skills to work closely with EMS, adds Hall. "EMS starts what we as nurses continue. We just need to know where our field team left off," he says. "The rest is just coordinating solid teamwork at all levels, and that is what we do best."


For more information on reducing delays to CT scan, contact: