Sequence of events on recognition of potential endovascular AIS patient:
- Call stroke attending
- Call neuroIR fellow. If no answer, ask HUP operator for neurorads fellow on call or during business hours call neuroIR suite directly.
- Use Cureatr app to text neurovascular team “Acute Stroke Team (HUP)” a short summary of the case and what needs to be done on arrival (team includes R2 charge nurse, NIR fellow and NIR nurses). Include the HUP on-call consult JAR in the message.
- Text the neuro stroke resident orders that need to be put in (CT +/-CTA/P on arrival, in addition to stat NIR consult – so the case can be booked). Sometimes a stat inpatient COVID swab will need to be ordered if no test was done at OSH.
- Transfer center/PennStar will be aware of transfer and will send out an ETA page. If not call PennStar and ask them to send out a page
*If the call did not originally go through the transfer center (i.e., resident calls you for stroke alert from Presby/Pensy), make sure to involve the transfer center ASAP to get the transfer process started.
During call with outside hospital:
- Verify if intubated – if yes, call R2 nurse to ask them to get respiratory to come to CT also
- Ask if patient is on any drips; if so, let R2 nurse know and check to see if ED pharmacist is available to assist on arrival
- Ask if rapid COVID test was sent; if no, request test be sent ASAP as a rapid
- Ask about troponin/EKG changes
- Ask them to place Foley
- Consider asking for 20 gauge IV in R antecub or forearm if delay in transfer expected
- Get family contact info (cell number)
- Ask PennStar for ETA
Activating patient in UPHS system on arrival:
As soon as the patient arrives, The NICU charge nurse will call admissions and notify them that the patient should be “ACTIVATED to Radiology Station”(CTA). Triple check with RN to make sure this step is done. If you end up calling because NICU RN is busy with patient care, call admissions and tell whoever answers the phone that this is a “Level 0 transfer, needs an emergent CTA and must be activated immediately”. The orders will drop and the scan can be completed.
Interaction with PennStar and NICU clinical lead RN:
- PennCOMM will intake the neuro emergency call in usual fashion.
- Stroke MD will accept the patient and inform PennCOMM of patient destination at HUP (R2, Silver 9 or CT)
- When the aircraft or ground transport departs the referring center, Pennstar will call the R2 Clinical Lead RN phone at 215-380-4592 with at least a 15 minute ETA. Sometimes this may be a longer ETA, on occasion (Chester County Hospital) it may be a bit shorter. This call will be for ALL neuro emergency patients, not just those going to CT scan. This way you will have an accurate ETA regardless of patient destination at HUP (R2 or CT)
- When PennStar arrives at HUP will meet the stroke team in the ER CT scanner if directed to do so.
- Will give report to the R2 Clinical Lead RN and the stroke MD who will assume care in CT freeing Pennstar staff to resume duties