Date of Award

Fall 2025

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Doctor of Nursing Practice

Degree Name

Other

First Advisor

Cathleen Colleran

Abstract

Background: An acute stroke is a potentially life-threatening medical condition that may lead to significant morbidity and mortality. It is imperative that patients seek emergent medical attention as several of the known interventions are time-limited based upon the time of symptom onset. Once patients present for evaluation, it is of equal importance for medical professionals to recognize that someone may be experiencing an acute stroke and to escalate their care appropriately. Among the various evidence-based stroke assessments, the National Institute of Health Stroke Scale (NIHSS) is often implemented given its ability to detect acute neurological abnormalities and estimate stroke severity. Given the known implications of assessment and intervention on patient safety and outcomes, a local emergency department microsystem’s stroke assessment process was studied.

Local Problem: The microsystem’s stroke alerts from February 2025 to May 2025 were reviewed, making note of the frequency at which the NIHSS assessment was completed. During these months, there were a total of 130 (N = 130) stroke alerts. Of these stroke alerts, 93 (n = 93 [72%]) had a documented completed NIHSS assessment. To improve this process, a quality improvement project was initiated with the specific aim to increase the monthly average of completed NIHSS assessments among stroke alert patients in the emergency department from 72% to 85% by September 30, 2025.

Methods: The Plan-Do-Study-Act model of improvement served as the framework for this initiative. A root cause analysis identified ambiguity regarding who and when to perform the assessment. This informed the development of a flowchart which highlighted the step in the process for the assessment to be completed. Pre- and post-intervention surveys were created to help estimate the impact of the intervention. The survey results were analyzed via descriptive statistics. The September 2025 stroke alerts were also reviewed to determine if the specific aim had been met.

Intervention: The project was introduced to the microsystem’s registered nurses (RN) after which they could enroll to participate. The participants completed a pre-intervention survey which assessed their baseline understanding of the NIHSS. Then, during an in-person meeting, they were introduced to the flowchart. After this meeting, they completed a post-intervention survey which was used to estimate the impact of the intervention. Once the intervention had concluded, the September 2025 stroke alerts were reviewed.

Results: 22 RNs participated in the intervention. The survey responses suggested that the intervention contributed towards standardizing the NIHSS assessment process. Upon review of the September 2025 data, there were a total of 39 (N = 39) stroke alerts. Of the total, 30 (n = 30 [77%]) had a completed NIHSS assessment.

Conclusions: The results from the post-intervention chart reviews suggest that the project’s specific aim was not met after one intervention cycle. However, the survey responses indicate that the intervention improved the RNs’ understanding of when to complete the NIHSS. It is recommended that this project continue with subsequent cycles in efforts to further improve this process to ensure patients receive safe, timely, and effective care.

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