Abstract W P359: Stroke Symptom Identification: Using a Modified ROSIER SCALE at Emergency Room Triage

Background and Issues: Stroke patients can arrive to the emergency room via Emergency Medical Services (EMS) or ambulatory at triage. Processes are already in place to identify stroke patients in the field such as the Cincinnati Pre-hospital Stroke Scale used by the Emergency Management Services (EMS) and early notification to the hospital emergency room staff. Data showed that approximately 68% of stroke patients at this stroke center arrived by or were brought to the hospital by self, family, or coworkers and not by EMS. Our main goal was to improve the process for recognizing stroke symptoms for patients who do not arrive by EMS and minimize delays to activating the Stroke Code Team Page in the triage area. Methods: The first step was to identify the barriers or delays that nurses had with initiating a stroke code alert. Stroke code activations were delayed because of uncertainty of who should call it and some nurses did not feel confident in their decision to activate the stroke code alert without consulting the emergency room physician. It was determined that the nurse would feel more empowered if there was more clarity to their roles and responsibilities during the assessment phase and there was an assessment tool available to guide them to the decision to activate the stroke team page. A modified version of the “Recognition of Stroke in the Emergency Room” (ROSIER) scale was implemented for the nurses to evaluate a patient that presents with stroke like symptoms. In addition to clarify their roles a workflow chart was deployed to show each team member their specific roles and responsibilities during this process. Results: Prior to the implementation of the ROSIER scale at triage the activation of stroke codes at triage were inconsistent. After education of the ED nurses and implementation of the ROSIER SCALE at triage there was a significant increase in the activations of stroke codes by ED nurses and a decrease in the time from triage to stroke team activation. Conclusions: Using an assessment tool like the ROSIER Scale in addition to clarifying the roles and responsibilities of the team can reduce delays to identifying acute stroke symptoms in patients at a busy emergency room triage area and improve opportunities for timely interventions.