Acute Stroke Response Team

What's The Difference?

Tier 1 Activation: Typical stroke activation involving resident, stroke RN, Stroke Staff. All in houses activations, tPA transfers, transfers for likely intervention will remain Tier 1 activations. Nothing else will change regarding these. They will continue to be the majority of activations that we see.

Tier 2 Activation: This will involve only stroke transfer patients deemed to be stable by the stroke staff, are deemed not to be intervention candidates, and do not receive tPA. Imagine mild subacute stroke patient or TIA patient that we accept as transfers. These patients are admitted to the Neurology telemetry floor for stroke workup. Only stroke attendings can designate a stroke activation to be Tier 2. These activations will involve stroke resident, stroke fellow, and stroke attending only. The stroke RN will be notified of these patients but will not be required to evaluate the patient acutely on arrival. If a Tier 2 patient is deemed to be unstable, all providers involved can escalate a Tier 2 activation to a Tier 1 activation by calling the hospital operator. This will alert the stroke RN who will assist in the care and evaluation of the patient. There should be a discussion between stroke staff and residents regarding all transfer patients and whether they are Tier 1 vs Tier 2 on arrival.