A Checklist to Improve Acute Stroke Evaluation and Treatment in the Emergency Department.

Abstract

Narrow therapeutic time windows and delays in assessing acute ischemic stroke patients limit the access to and effectiveness of reperfusion therapies. A 2-year quality improvement project codesigned and tested a checklist for quicker evaluation of suspected stroke cases in 2 emergency departments (EDs). Utility, feasibility, and implementation barriers were assessed through semistructured interviews. The impact on stroke quality metrics was analyzed using bivariate and multivariate regression models with data from the American Heart Association's Get With the Guidelines registry. Implementing the checklist was significantly associated with higher odds of receiving intravenous thrombolytics within 60 minutes of ED arrival (odds ratio: 6.4, 95% confidence interval: 1.1-68.7, P = 0.03). Users felt the checklist improved the standardization of stroke care and promoted teamwork, especially in a time of higher staff turnover. An ED-based stroke checklist resulted in timelier stroke care for acute ischemic stroke patients, meriting further testing in larger, more diverse settings.