Acute Stroke Nurses improve Code Stroke activation and ED processes of care: Results of the Code Stroke 2.0 Feasibility Study [Meeting Abstract]

Background: Fever, Sugar and Swallow (FeSS) protocols following stroke reduce death and dependency. However, introduction of these protocols in the T3 Trial did not improve Emergency Department (ED) stroke care processes nor patient outcomes. We aimed to determine if a revised Code Stroke (CodeStroke2.0) pathway facilitated by a specialist Acute Stroke Nurse (ASN) role could: i) improve CodeStroke2.0 activation and ii) increase uptake of FeSS interventions in ED while promoting faster transfer to the stroke unit. Methods: Single-centre, pre-test/post-test design feasibility study. Data from patients receiving usual care prior to ASN introduction were compared to data following ASN introduction. Primary outcome: proportion of patients with activated CodeStroke2.0 on ED arrival. Secondary outcomes: ED length of stay, uptake of FeSS processes of care, and thrombolysis metrics. Analyses were adjusted for age, sex and stroke severity using logistic regression. Results: 117 patients in each cohort (n¼234). On ED arrival, patients from the post-test cohort had significantly more CodeStroke2.0 activations (Pre:6.8%; Post:61.5%;P<0.0001), formal blood glucose testing (Pre:54.7%; Post:98.3%;P<0.0001) and but not temperature recordings (Pre:62.4%; Post:73.5%;P0.0649). There were significantly fewer oral medications given prior to swallow screening (Pre:30.8%; Post:13.7%;P¼0.0017) and more stroke unit transfers <4 hours from ED arrival (Pre:26.5%; Post:41.0%;P¼0.0094). Thrombolysis rates were unchanged. However, the proportion of patients screened for tPA eligibility increased (Pre:n¼53.0%; Post:n¼80.3%;P<0.0001). Conclusion: ASN introduction was associated with improved CodeStroke2.0 activation, FeSS processes of care, and stroke unit transfer. The ASN role should be introduced into hospitals as part of routine stroke care.