Dissertation
Improving Early Stroke Detection for Veterans in the Emergency Room: A Quality Improvement Project
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background: Annually, approximately 795,000 individuals in the United States experience a stroke. Veterans are at a heightened risk due to higher rates of traumatic brain injuries (TBI), increasing their stroke risk by 40%. Smaller Veterans Health Administration (VHA) facilities face challenges in providing timely stroke interventions due to inadequate access to diagnostic resources and limited nursing expertise. Education for nurses focusing on atypical stroke symptoms (altered mental status, headache, nausea, vomiting, dizziness and falls) in Emergency Department (ED) triage can improve patient outcomes.Purpose: The purpose of this project was to enhance the recognition of stroke in patients presenting with atypical symptoms and improve the timeliness of stroke interventions for veterans in a Midwest Veterans Affairs (MWVA) ED.Methods: Utilizing the Plan-Do-Study-Act (PDSA) Framework, this project implemented cranial nerve assessments for veterans presenting with atypical stroke symptoms. Educational interventions included pre and post cranial nerve knowledge exams, and in-service training for ED nurses. Data collection involved chart audits and surveys to measure the impact of education on documented cranial nerve assessments in atypical stroke.Findings: There was a significant increase in post-education neurological exams (n=31) compared to pre-education neurological exams (n=20) on patients with atypical stroke symptoms. Chi-square testing indicated a significant relationship between education and the frequency of neurological exams (?2(1) = 7.40, p = .007). No patient with atypical stroke symptoms was diagnosed with a stroke during the project timeframe.Discussion: Educational interventions improved nurse knowledge and increased documented cranial nerve assessments in ED triage. Documentation menus within the triage note were limited, suggesting a need for expanding documentation tools in the electronic health record (EHR). Future initiatives could include enhancing triage documentation processes and expanding stroke education programs.
Details
- Title: Subtitle
- Improving Early Stroke Detection for Veterans in the Emergency Room: A Quality Improvement Project
- Creators
- Ann E Morgan - University of Iowa
- Contributors
- Julie Ann Stanik-Hutt (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Adult/Gerontology Nurse Practitioner (Acute Care)
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Ann E Morgan
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841037002771
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