Striving to improve the time window for stroke treatment

Fast, quality care for stroke patients is the goal for Kirstin Buchanan and the team that works on UCHealth’s Mobile Stroke Treatment Unit.

Always striving to improve the time that it takes for a patient to receive life-changing medication and treatment, Buchanan embarked on a UEXCEL project two years ago to consider using a new assessment tool to identify patients who have a large vessel occlusion stroke that affects a large portion of the brain.

The MSTU is an ambulance equipped to diagnose and treat strokes in a prehospital setting – a patient’s living room, a car on the side of Interstate 25, or the meat aisle at King Soopers. Nurses, paramedics, EMTs and CT technologists aboard the MSTU conduct assessments, perform CT scans, and transmit the images to a neuro radiologist, who discusses the results with a neurologist at UCHealth who, in many cases, authorizes the delivery of a clot-busting drug, tPA, in the prehospital setting.

The New England Journal of Medicine has published the results of the BEST-MSU study, showing that patients treated aboard an MSTU are 2.5 times more likely to have a better outcome. For every second that treatment is delayed, an average of more than 30,000 neurons die.

Buchanan’s project evaluated whether using a stroke assessment tool to evaluate an assessment tool called VAN – vision, aphasia and neglect, which occurs when there is a deficit in attention or awareness to one side of the field of vision or to the affected limb — in concert with the traditional NIHSS stroke assessment tool, could save time for patients who had a large vessel occlusion stroke. The project also included educating all staff members on how to use the VAN and ultimately, rewriting protocols and guidelines to include use of the VAN onboard UCHealth’s MSTU.

When responding to a possible stroke, the MSTU team begins assessing patients immediately upon meeting the patient.

“Hi, I’m Kirstin. I’m a nurse, and I’m here to help you. Can you tell me what day it is?’’ Buchanan begins. The team is also looking for telltale signs of stroke:

• B – Balance
• E – Eyes
• F – Facial drooping
• A – Arm weakness
• S – Slurred speech
• T – Time (call 911)

After the initial assessment, the MSTU team takes a deeper dive into the VAN and NIHSS assessments. At the same time, they’re preparing the CT scan for the patient, alerting a hospital, and then transmitting images of the patient’s brain to a neuro radiologist waiting at a UCHealth hospital for review.

If the CT scan shows blood in the brain, the patient has had a hemorrhagic stroke. These patients can receive medications on board the MSTU to slow bleeding and are transported to the hospital. If the CT scan shows no blood, the patient is likely having an acute ischemic stroke, meaning a vessel is clogged with a clot, preventing blood flow throughout the brain.

If an ischemic stroke is diagnosed, the team then wants to determine whether the patient has a blood clot in a large vessel. Then, the team prepares the patient for the CT-angiogram by injecting contrast dye. That CT-angiogram is then transmitted to a neuro radiologist at a UCHealth hospital, who can then ready the team in the interventional radiology suite to perform a thrombectomy to remove the clot from the vessel.

Limited data, gathered since January 2022, shows the use of VAN has expedited large vessel occlusion patient assessments in the prehospital setting. That, in turn, has expedited CT-angiogram and identified candidates to be transported to a Comprehensive Stroke Care Center to receive mechanical thrombectomies.

Upon completion of the project, Buchanan became the first nurse at Memorial Hospital to achieve Level IV with UEXCEL, UCHealth’s Nursing Practice and Credentialing Model.

“It’s saving a lot of time, and it’s really beneficial for the patients,” Buchanan said.