Mark Goldberg, MD UT Southwestern Medical Center LSS Annual Meeting - November 6, 2015.
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Transcript of Mark Goldberg, MD UT Southwestern Medical Center LSS Annual Meeting - November 6, 2015.
NASCARENursing-driven Acute Stroke Care
Mark Goldberg, MDUT Southwestern Medical CenterLSS Annual Meeting - November 6, 2015
Julian Yang, MD (now at Duke)
Michelle Provencher, RN, MS◦ LSS and NASCARE Lead Coordinator
Mark Goldberg, MD (PI) DaiWai Olson, RN, PhD Robin Novakovic, MD Steven Figueroa, MD
TBN research coordinator
Investigator Team
The target time for delivery of IV TPA is < 60 min from hospital arrival (door-to-needle time)
Many hospitals do not meet this metric
Average door-to-physician log-on time in telestroke encounters nationwide was 76.3 minutes Ref: Targeting Telestroke: Benchmarking Time Performance in
Telestroke Consultations (Yang et al., 2013)
Background
Acute stroke delivery metrics can be improved by providing ED nurses with:◦An educational platform ◦An organizational tool◦A standardized stroke code protocol based
on core principles inspired by a “pit stop” care model
NAS-Care Hypothesis
1. Identification of shared goals
2. Organized urgency with the removal of gatekeepers
3. Multi-personnel, parallel processing
4. Focus on defined staged roles and tasks
5. Empowered engagement, empowered responsibility
NAS-Care Principles
The nurse is the usually the first person to see the patient
Takes responsibility for t-PA <60 minutes
Provides information needed to make a t-PA decision to physician as quickly as possible
The RN is the DRIVER
Phase 1 – Site Selection and PreparationPhase 2 – Data Collection: Baseline (3 months)Phase 3a – NAS-Care Protocol Implementation
o NIHSS trainingo Site Visit
• Educational Lecture: “Time is Brain/Racing to the Finish”
• Mock Code Drills - “The 30-minute Stroke Code”o NAS-Care Run Sheet Implementation
Phase 3b – Data Collection: NAS-Care (6 months)Phase 4 – Exit Procedures
NASCARE Research Plan
Door-to-Provider (DTP) Door-to-CT (DTCT)
Door-to-Ready (DTR)◦“Ready” signifies acquisition of all data points
needed to make a decision for t-PA
Door-to-Specialist (DTS) Door-to-Needle (DTN)
Key Metrics
NAS-Care started data collection eight months ago
Two hospital in East Texas are currently collecting data
To date, 86 patients have been enrolled
NAS-Care Progress
Three more hospitals in North and West Texas to start data collection in the next year
Partner hospitals of other LSS coordinating centers to start data collection◦ UT Health Science Centers – San Antonio and
Houston have made great progress, and are both IRB approved
◦ Seton Healthcare Family is currently waiting for any proposed changes to be finalized
Reviewing for possible protocol changes for endovascular therapy
Future direction
Thank You