Triage, treatment, and transfer: evidence-based clinical practice recommendations and models of nursing care for the first 72 hours of admission to hospital for acute stroke.

S troke is a medical emergency and care provided in the first hours is critical in shaping patients' long-term recovery and prognosis. 1 There is robust evidence demonstrating significant reductions in death and disability with early interventions in acute stroke care, including antiplatelet therapy 2 stroke unit (SU) care 3 and thrombolysis. 4 International clinical guidelines for stroke provide key recommendations to guide clinical practice 5–8 ; however, uptake of evidence-based care is variable and often less than optimal. For example, among patients with ischemic stroke, rates for treatment with intravenous recombinant tissue-type plasminogen activator (r-tPA) are relatively low in the USA (5%) 9 and Australia (7%), 10 compared with Canada (12%) 11 and some European centers (14%). 15 Nurses play a pivotal role in rapid identification and triage of patients with acute stroke, initial assessment, and coordinating the timely flow of patients with acute stroke through the health system. Nurses enable delivery of relevant time critical treatments, and rapid transfer to acute SUs for ongoing assessment and provision of further treatment. The purpose of this article is to highlight nursing's essential contribution to the expedient delivery of acute stroke care by providing evidence-based recommendations for clinical practice processes of care and models of care where nurses have a pivotal role during the first 72 hours from arrival at the emergency department through to SU care. A more detailed comprehensive overview of nursing and interdisciplinary care for patients with acute ischemic stroke extending beyond the first 72 hours has been published previously. 16 Where available in existing guidelines, the class and level of evidence for recommendations shown in tables have been provided using the American Heart Association taxonomy. 6 As there is a dearth of evidence from high-quality stroke nursing research, not all the recommendations described in this article have been evaluated using randomized controlled trials. Therefore, we have included examples of clinical models and systems for which lower levels of evidence suggest improvement in patient outcomes or a reduction in barriers to rapid assessment and management of stroke. 17–19 Furthermore, we also have included models of care that emphasize the multidisciplinary team, as examination of nursing care in isolation from care provided by other health professionals does not reflect current evidence-based practice. Where no rigorous evidence exists for a recommendation, we have labeled it a good practice point. 7 Finally, opportunities for future research are identified in an effort …