Large Vessel Occlusion Identification through Rapid Arterial Occlusion Evaluation

Abstract

Large vessel occlusions account for nearly half of all acute ischemic cerebrovascular accidents and have an increased risk of morbidity and mortality. Screening suspected stroke patients in the prehospital setting with the Rapid Arterial Occlusion Evaluation Scale allows for prompt recognition and intervention of potential large vessel occlusions. A quality improvement project was designed to standardize the utilization of the Rapid Arterial Occlusion Evaluation Scale among four emergency medical service stations serving a medical center. The project included education of emergency medical service technicians, education of emergency department staff, and the design of a Rapid Arterial Evaluation screening tool. Lewin’s Change Theory was utilized as the framework to guide the project. Utilization of the Rapid Arterial Occlusion Evaluation Scale was tracked among four emergency medical services for twelve weeks. During the twelve-week implementation, twenty suspected stroke patients were treated and prehospital screenings were completed for sixteen of the twenty patients. Two large vessel occlusions were identified with a Rapid Arterial Occlusion Evaluation Score greater than five and both were positive for a large vessel occlusive cerebrovascular accident. One of the large vessel occlusive patients underwent a mechanical thrombectomy and surpassed the medical center’s treatment goal of less than two hours from arrival to the facility. This project aligns with the Triple Aim Initiative to reduce healthcare cost, improve patient experience, and improve population health.