Abstract P843: Stroke Patient Monitoring Used in Adult Emergency Department During Covid-19 Acting Both Rapidly and Safely

Introduction: The healthcare system was facing two challenges: acute patients presenting to the adult emergency department diagnosed with Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)/ COVID-19 and how to treat life-threating emergencies. Emergency, neurovascular and multidisciplinary teams, therefore, had to be ready to treat these emergencies rapidly and safely. The goals were to balance substantial needs and preserve resources during this extraordinary time for incoming acutely ill patients. Background: The World Health Organization (WHO) defined COVID-19 as a pandemic. New York City was the epicenter for the 2019-2020 COVID -19 pandemic. There were 30,000 confirmed cases resulting in over 2,500 hospitalizations as of March 30, 2020. Hence, it was vital to develop new monitoring protocols, based upon the expert opinion of the stroke and multidisciplinary leadership at New York Presbyterian Hospital that required minimum monitoring and criteria for admission necessary to safely care for complex stroke patients. Purpose: This quality improvement project evaluated patient outcomes after the implementation of the modified stroke protocol. Methods: Retrospective data review was conducted for patients who presented via the Emergency Department with stroke symptoms, and were treated with intravenous thrombolysis (IVT) between 3/30 and 6/30/2020, with a focus on whether patients required a higher level of care or developed hemorrhagic transformation post IVT. Results: The sample consisted of 10 patients (60% female), median age 54 (range 37-73). Length of stay ranged from 2 to 12 days. Two patients (20%) were SARS-CoV-2 positive. None (0%) of the patients developed hemorrhagic transformation. None (0%) of the patients admitted to non-ICU units required critical care transfer or interventions within 24 hours of receiving IVT. Six (60%) patients were discharged to home. Conclusions: Using the modified patient monitoring protocol post IVT none of the patients developed symptomatic hemorrhagic transformation and did not require transfer to higher level of care within 24 hours. If there is another wave of the COVID-19 pandemic, this protocol could be adopted and its effectiveness and safety can continue to be evaluated.