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Background Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment with tissue plasminogen activator (t-PA) than standard m...

Introduction: Most clinical research stopped during COVID due to possible impact on data quality and personnel safety. We aimed to assess the impact of COVID on study conduct at sites that continued to enroll patients during the pandemic. Methods: BEST-MSU is an ongoing study of Mobile Stroke Units (MSU) vs standard management of tPA eligible acute stroke patients in the pre-hospital setting. MSU personnel include a vascular neurologist via telemedicine, and a nurse, CT tech, and medics on board using appropriate PPE. During COVID, consent, 90 d mRS and EQ5D could be obtained by phone instead of in person, otherwise management was the same. We compared patient demographics, study metrics, and infection of study personnel during intra- vs pre-COVID eras. Results: Four of 6 BEST-MSU sites continued to enroll during COVID. There was no difference in intra- (n= 41) vs pre- (n= 763) COVID enrolled tPA eligible patients’ age, sex, race (45% vs 41% Black), ethnicity (23% vs 19% Hispanic), or NIHSS (12 vs 12). MSU alert frequency did not change, but percent of screened patients enrolled and treated with tPA declined to 12% from 23% (p Conclusion: Clinical research in the pre-hospital setting can be carried out accurately and safely during a pandemic. Study enrollment and tPA treatment rates declined, but otherwise there was no difference in patient demographics, deterioration of study processes, or serious infection of study staff.

Most clinical research stopped during COVID due to possible impact on data quality and personnel safety. We aimed to assess the impact of COVID on acute stroke clinical trial conduct at sites that continued to enroll patients during the pandemic. BEST-MSU is an ongoing study of Mobile Stroke Units (MSU) vs standard management of tPA-eligible acute stroke patients in the pre-hospital setting. MSU personnel include a vascular neurologist via telemedicine, and a nurse, CT technologist, paramedics and emergency medicine technicians on-board. During COVID, consent, 90-day modified Rankin Scale (mRS) and EQ5D were obtained by phone instead of in-person, but other aspects of management were similar to the pre-COVID period. We compared patient demographics, study metrics, and infection of study personnel during intra- vs pre-COVID eras. Five of 6 BEST-MSU sites continued to enroll during COVID. There were no differences in intra- (n = 57) vs pre- (n = 869) COVID enrolled tPA eligible patients’ age, sex, race (38.6% vs 38.0% Black), ethnicity (15.8% vs 18.6% Hispanic), or NIHSS (median 11 vs 9). The percent of screened patients enrolled and adjudicated tPA eligible declined from 13.6% to 6.6% (p < .001); study enrollment correlated with local stay-at-home and reopening orders. There were no differences in alert to MSU arrival or arrival to tPA times, but MSU on-scene time was 5 min longer (p = .01). There were no differences in ED door to CT, tPA treatment or thrombectomy puncture times, hospital length of stay, discharge disposition, or remote vs in-person 90-day mRS or EQ5D. One MSU nurse tested positive but did not require hospitalization. Clinical research in the pre-hospital setting can be carried out accurately and safely during a pandemic. tPA eligibility rates declined, but otherwise there were no differences in patient demographics, deterioration of study processes, or serious infection of study staff. Trial registration: NCT02190500

Background: For stroke patients, the in-hospital care is focused on the initial stroke treatment, secondary prevention, functional assessment, and discharge planning. Despite focused education by nursing and thorough discharge planning, patients often express frustration and concerns regarding their hospital stay, and patient satisfaction scores remain low at 75%. Methods: A pilot program was implemented in the acute care setting in which a stroke survivor, himself a former hospital patient, visited stroke patients and their families during admission. He provided services twice a week on the inpatient units, which included answering questions regarding his own experience surviving a stroke and keeping a log of concerns patients and families expressed during the sessions. These concerns were immediately relayed to the nursing staff caring for the patients, and also reviewed and categorized by the stroke coordinator and program manager. Results: Since September 2018, the stroke survivor has visited 96 patients. The majority of patients expressed concerns about their functional recovery. Additional concerns included return to normal life following their stroke, how to obtain state and federal benefits, and how to prepare foods for modified diets. These concerns had not been elicited by the clinical care team. Prior to the program’s initiation, overall stroke patient satisfaction scores averaged 75% annually with high variability. These scores increased to 89.4% with low variability and have persisted for 8 months. Similarly, nursing communication scores averaged 75% and increased to 90% after implementation. Conclusions: A stroke survivor pilot program is feasible and effective for improving patient satisfaction, both overall and related to nursing communication. Patients and family members may find it easier to speak with a person who shares similar experiences, such as a stroke survivor. These additional insights to patients’ concerns allow the care team to optimize patient care and improve patient satisfaction. Future expansion of the program may include a broader role for the stroke survivor, leveraging the effective communication provided by this unique role.