Endovascular intervention for acute stroke

Sequence of events on recognition of potential endovascular AIS patient-

1.  Call stroke attending
2.  Call neuroIR fellow – Aaron Bress- 267-689-8260 to July 1 2016, then Martin Oselkin – 917-622-2635.  If no answer, ask HUP operator for neurorads fellow on call or during business hours call neuroIR suite directly 662-3064.
3.  Call R2 clinical lead nurse/ R2 charge nurse 267-438-0115; if no answer call INCU charge at 215-206-8722 (PennStar should call as well)
4.  Call neuro consult JAR  –  215-260-1959 – ask them to 1) put in orders for CT/CTA head and neck (tell them to release orders immediately – this works, tell JAR to use the button that looks like a clipboard and a forward arrow), 2) put in order for Consult to neurointerventional radiology.  PennStar should alert CT for upcoming acute stroke patient but you may want to call yourself as well (215-662-3084).
5.  Transfer center should be alerted by PennStar on patient arrival to activate patient in EMR- if problems call transfer center at 215-662-3555

During call with outside hospital –

  1. Ask them to place Foley
  2. Get family contact info (cell number)
  3. Verify if intubated – if yes, when R2 nurse called ask them to get respiratory to come to CT also
  4. Verify creatinine
  5. Consider asking for 20 gauge IV in R antecub or forearm if delay in transfer expected
  6. Ask PennStar for ETA

Activating patient in UPHS system on arrival:

Do not move the patient in Navicare or in any other way indicate that the patient has arrived prior to the actual patient arrival.  Once the decision is made to transfer the patient, the patient is “ACCEPTED” by the transfer center.  The transfer center will then arrange transport and the patient is “REGISTERED”.  As soon as the transfer center submits the reservation, (which should occur within about 5 minutes but is dependent upon getting the faxed information from the transferring facility so it is done ASAP),
1. Labels and a bracelet can be printed. (prior to patient arrival).
2. Pre admit orders for the CTA can be put in the system. (prior to patient arrival).

As soon as the patient arrives, place a call to 215-662-3555, the TRANSFER CENTER, and notify them that the patient should be “ACTIVATED to Radiology Station”(CTA). 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

1- PennCOMM will intake the neuro emergency call in usual fashion.
2- Stroke MD will accept the patient and inform PennCOMM of patient destination at HUP (R2, Silver 9 or CT)
3- When the aircraft or ground SCT departs the referring, 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 from us regardless of patient destination at HUP (R2 or CT)
4- When PennStar arrives at HUP will meet the stroke team in the ER CT scanner if directed to do so.
5- 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