Improving Acute Stroke Care with an Implementation Science Guided Acute Stroke Nurse Pilot Project

Abstract

Background: Ischemic stroke treatment necessitates timely intervention, including intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), to optimize patient outcomes. Increasing patient volumes and staffing challenges have contributed to deviations from acute stroke protocols. This quality improvement initiative evaluated the implementation of an Acute Stroke Nurse (ASN) role at a Comprehensive Stroke Center to enhance stroke alert coordination, post-thrombolytic monitoring, and patient care transitions.

Methods: A 12-week pilot program introduced the ASN role, focusing on acute stroke response and monitoring after IVT administration. Guided by implementation science frameworks, including the Consolidated Framework for Implementation Research (CFIR), Expert Recommendations for Implementing Change (ERIC), and the Implementation Research Logic Model (IRLM), the initiative assessed door-to-treatment times, post-thrombolytic monitoring compliance, and staff perceptions of the role. Quantitative metrics, validated scales for acceptability and appropriateness (AIM and IAM), and thematic analysis of feedback informed the evaluation.

Results: The ASN role was piloted with partial coverage (median 3.5 days per week). Although door-to-needle times for IVT did not improve, door-to-puncture times for MT decreased by 28.3% (mean 39.4 minutes compared to 55 minutes pre-pilot). Compliance with vital sign and neurologic monitoring improved by 40.4% and 11.1%, respectively, in the critical post-thrombolytic period. Staff surveys (n=45) demonstrated high acceptability (AIM=4.77) and appropriateness (IAM=4.81), with strong support for the role’s expansion. Based on these findings, two full-time equivalent (FTE) positions were approved to sustain and expand the ASN role.

Conclusions: The pilot demonstrated the ASN role’s impact on enhancing monitoring compliance, reducing treatment times for mechanical thrombectomy, and improving staff satisfaction. These findings support the role's scalability and highlight the value of structured implementation science approaches in advancing evidence-based stroke care practices.