1. Mark Goldberg, MD UT Southwestern Medical Center LSS Annual Meeting - November 6, 2015

2.  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

3.  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)

4.  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

5. 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

6.  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

8. Phase 1 – Site Selection and Preparation Phase 2 – Data Collection: Baseline (3 months) Phase 3a – NAS-Care Protocol Implementation o NIHSS training o Site Visit E ducational 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

9.  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)

10.  NAS-Care started data collection eight months ago  Two hospital in East Texas are currently collecting data  To date, 86 patients have been enrolled

11.  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