J Emerg Nurs. 2022 Jul;48(4):406-416. doi: 10.1016/j.jen.2022.01.013. Epub 2022 Apr 27.
Nursing care is widely recognized to be a vital element in stroke care delivery. However, no publications examining clinical education and optimal workflow practices as predictors of acute ischemic stroke care metrics exist. This study aimed to explore the impact of a nurse-led workflow to improve patient care that included telestroke encounters in the emergency department.
A nonrandomized prospective pre- and postintervention unit-level feasibility study design was used to explore how implementing nurse-driven acute stroke care affects the efficiency and quality of telestroke encounters in the emergency department. Nurses and providers in the emergency department received education/training, and then the Nursing-Driven Acute Ischemic Stroke Care protocol was implemented.
There were 180 acute ischemic stroke encounters (40.3%) in the control phase and 267 (59.7%) in the postintervention phase with similar demographic characteristics. Comparing the control with intervention times directly affected by the nurse-driven protocol, there was a significant reduction in median door-to-provider times (5 [interquartile range 12] vs 2 [interquartile range 9] minutes, P < .001) and in median door-to-computed tomography scan times (9 [interquartile range 18] vs 5 [interquartile range 11] minutes, P < .001); however, the metrics potentially affected by extraneous variables outside of the nurse-driven protocol demonstrated longer median door-to-ready times (21 [interquartile range 24] vs 25 [interquartile range 25] minutes, P < .001). Door-to-specialist and door-to-needle times were not significantly different.
In this sample, implementation of the nurse-driven acute stroke care protocol is associated with improved nurse-sensitive stroke time metrics but did not translate to faster delivery of thrombolytic agents for acute ischemic stroke, emphasizing the importance of well-outlined workflows and standardized stroke code protocols at every point in acute ischemic stroke care.
护理被广泛认为是中风护理服务的重要组成部分。然而，目前尚无研究探讨临床教育和最佳工作流程实践作为急性缺血性脑卒中护理指标的预测因素。本研究旨在探讨以护士为主导的工作流程对改善患者护理的影响，该流程包括在急诊科进行远程卒中会诊。
采用非随机前瞻性前后干预单位水平可行性研究设计，探讨实施以护士为主导的急性脑卒中护理如何影响急诊科远程卒中会诊的效率和质量。急诊科的护士和医务人员接受了教育/培训，然后实施了《护士主导的急性缺血性脑卒中护理方案》。
对照组有 180 例急性缺血性脑卒中患者（40.3%），干预组有 267 例（59.7%），两组患者的人口统计学特征相似。直接受以护士为主导的方案影响的对照组和干预组时间比较，医生到达时间中位数明显缩短（5[四分位距 12]vs2[四分位距 9]分钟，P<0.001），CT 扫描到达时间中位数也明显缩短（9[四分位距 18]vs5[四分位距 11]分钟，P<0.001）；然而，可能受以护士为主导的方案之外的其他变量影响的到达准备就绪时间中位数较长（21[四分位距 24]vs25[四分位距 25]分钟，P<0.001）。医生到达时间和到达溶栓时间无显著差异。
在本研究样本中，实施以护士为主导的急性脑卒中护理方案与改善护士敏感的脑卒中时间指标相关，但并未转化为急性缺血性脑卒中更快地给予溶栓药物，这强调了在急性缺血性脑卒中护理的各个环节制定明确的工作流程和标准化的脑卒中编码方案的重要性。
