What has your ED done to improve stroke care?

When Joint Commission surveyors arrive in your ED to assess stroke care, they’ll have one thing on their minds: What you’re done to improve and speed assessment and treatment.

"We knew the best practices we would be judged on were: Lab drawn and sent within 10 minutes, patient seen by physician within 10 minutes, and patient to computerized tomography [CT] within 40 minutes," says Pat Laufmann, RN, BSN, director of emergency services at Saint Vincent Healthcare in Billings, MT. "Everything we did were minor things in and of themselves, but over all, they had a huge impact on making us successful."

Key improvements

ED nurses reported the following changes to surveyors, to demonstrate how these goals are met:

  • Previously, if CT was ready as the patient arrived, sometimes the patient went there immediately before labs were drawn. "So in that case, we now draw the labs in CT," Laufmann says.
  • Stroke patients take priority over all other labs. "We ordered red biohazard bags and place stroke lab tubes in those. The lab easily identify that they must grab these first," she says.
  • During off hours, a CT technician was called in, but that is no longer needed. "They responded quickly, but still, it took time. We requested, and radiology agreed, that they would train more of their techs to do CTs, so we now have someone in-house 24/7," says Laufmann.
  • Triage nurses now use the same five assessment questions used by paramedics in the field. "If yes to all, we activate the stroke team," says Laufmann. "It gave consistency to patients being assessed at triage and eliminated delays in those that they just weren’t sure about."


For more information on stroke care, contact:

  • Pat Laufmann, RN, BSN, Director, Emergency Services, Saint Vincent Healthcare, 1233 N. 30th St., Billings, MT 59101. Telephone: (406) 237-4145. Fax: (406) 238-6967. E-mail: patricia.laufmann@svh-mt.org.