Nurse-driven rapid COVID-19 testing in emergency department stroke patients

Introduction: The COVID-19 pandemic presents obstacles to time sensitive emergencies, such as stroke care In acute strokes, knowing the COVID-19 status may help to preserve personal protective equipment (PPE) in patients in whom a thrombectomy may be indicated and helps to decrease unnecessary exposure This study aims to demonstrate that rapid evaluation of a patient's COVID-19 status is feasible without delaying treatment times Methods: An intradisciplinary team was convened to create a workflow for rapid COVID-19 testing The Abbott Rapid® COVID-19 swab kit and assay were stocked in the ED Pyxis, utilizing the narcotic count feature to ensure all swabs were accounted Upon activation of Code Stroke, the ED RN donned PPE and swabbed the patient's naso-oral pharynx The collected swab was labeled, placed in a bio-hazard bag, sanitized and handed to a second RN outside of the room The specimen was taken to a pre-alerted lab technician who prepped the assay after hearing the code stroke After specimen collection, the patient followed the normal code stroke pathway and was taken to the CT scanner Metrics were analyzed for the pre COVID-19 (January through April) and during active COVID-19 (May through July) periods Results: There were 136 code strokes from January thru July 2020 81 were during pre-COVID vs 55 during active-COVID 47 of 55 (96%) were swabbed, 2 (4%) of whom were positive There was no difference between pre-COVID and active-COVID door to CT initiated time (16 mins [IQR 13-24] vs 22 mins [IQR 13-25] p=0 75), door to CT resulted time (21 mins [IQR 15-26]) vs 23 mins [IQR 16-29] p=0 63) 18 patients received tPA pre-COVID and 5 during active-COVID with no difference in DTN (pre: 37 5 mins [IQR 30-43] vs active: 28 mins {IQR 26-41] p=0 37) Door to CT initiated was faster for those who had their COVID swab performed pre-CT (14 mins [IQR 11 5-16 5] p=0 034) vs post-CT (20 mins [IQR 17-28]) Likewise, door to CT resulted was also faster pre-CT: 24 mins [IQR 19-32] vs post-CT: 17 mins [IQR 15-23] (p=0 04) Conclusion: The COVID-19 rapid swab code stroke process was feasible and did not delay treatment times