Date of Award

2011

Document Type

Thesis

Degree Name

Master of Science in Nursing (MSN)

First Advisor

Mary Alice Hodge

Abstract

Stroke is a common and serious health disorder, affecting approximately 795,000 people in the United States every year. Intravenous recombinant tissue plasminogen activator (IV rtPA) is the only FDA approved thrombolytic for treating acute ischemic stroke within 3 hours of symptom onset. Patients treated at rural health centers are often transported within hours to the closest primary stroke center. The purpose of this study was to evaluate the structure, process and outcomes related to the inter-facility transport of ischemic stroke patients treated with intravenous rtPA. The Quality-Caring Model© was the guiding framework.

A quantitative, retrospective, non-experimental analysis of inter-facility transport documentation was conducted. The study population included ischemic stroke patients treated with intravenous rtPA at a North Carolina hospital and were subsequently transferred to the primary stroke center. The study correlated structural and process components (type of transport, time of transport, and adherence to protocol) in relation to patient outcomes (presence of post rtPA intracerebral hemorrhage and discharge disposition).

The study sample size was considered too small to support statistical significance. However, the sample demonstrated the variation in terms of age, community and transport type. Factors associated with protocol adherence include: air medical transport, shorter transport times, and transporting with the intravenous rtPA infusing en route. Factors associated with protocol non-adherence include: night shift transport and transport times greater than or equal to 60 minutes. The research confirms the need for a state-wide guideline for inter-facility transport of ischemic stroke patients treated with intravenous rtPA.

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