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Abstract 1122‐000099: Establishing “Code NI” in Addition to “Code Stroke” is Warranted When Mechanical Thrombectomy is Needed


 Introduction
 : Hospital medical emergencies are prone to inefficiencies related to delayed dissemination of information, communication error, role confusion, and delayed decision making. The use of medical codes is intended to convey emergent and essential information quickly while preventing stress and mismanagement. The more complex, critical, and time sensitive an event is, the greater the need to establish a Code. Major mechanical thrombectomy (MT) trials published in 2015 and 2016 proved emergent MT to be more effective compared to IV tPA in stroke patients with large vessel occlusion (LVO). It has been proven that time to reperfusion with MT is directly proportional to severity of patient outcomes, coining the phrase, “save a minute, save a week”. When compared to the use of percutaneous intervention (PCI) in the treatment of STEMI, the number needed to treat for MT is estimated at 5 compared to 16 for PCI. Despite this fact, most hospitals have yet to adopt a code specific to MT. Our Purpose is to emphasize the importance of establishing a dedicated Code NI (Neuro‐Intervention) for stroke patients who require MT by sharing our
 
 
 Methods
 : After defining the problems, measuring the need, and analyzing the process, we identified the urgency for improvements in our facility. The administration was persuaded to support us in implementation of improvements after realizing the success of MT trials in patient outcomes, length of stay, hospital rankings, Comprehensive Stroke Center Certification, and insurance company compensation.
 
 
 Results
 : In early 2018, after many presentations and meetings, it was decided to implement “Code NI” for acute stroke patients who met MT criteria. Many teams and individuals including Neurointervention, Neuroradiology, Angio Suite, Anesthesia, ICU, Bed management, and transport were alerted. Following these implementations, from 2018 to 2021, our Door to Puncture Time and Puncture to Recanalization Time has been trending down from 219 to 120; and 261 to 147 minutes respectively.
 
 
 Conclusions
 : Approximately 70% of stroke patients with LVO have the potential of a meaningful recovery if treated efficiently and effectively. Establishing a “Code NI” for this time sensitive medical emergency helps the patients, their families, hospitals, and society.
