Abstract
Objectives Urgent mobilisation of the stroke team via ‘code stroke’ processes instigates rapid stroke clinical and neuroimaging assessment to identify individuals who would benefit from hyperacute stroke reperfusion therapy (as well as intracerebral haemorrhage treatments).1 Inappropriate code stroke activation may be associated with significant financial costs, opportunity costs and the potential for harm.
Methods The Medicare Benefits Schedule and SA Health Enterprise Agreements were utilised to determine code stroke related costs. A review of potential harm associated with inappropriate code stroke activation was conducted.
Results Inappropriate code stroke activation costs $371.45 per event in South Australia. Apart from cost related implications, it may delay the diagnosis of time-sensitive non-stroke differential diagnoses. It may also exacerbate certain stroke mimics such as cervical spine injury, humerus or neck of femur fractures. Code stroke imaging may confer both radiation and iodinated contrast related risks. Patients may also be investigated against their wishes in the hyperacute setting. In smaller centres with limited medical imaging capabilities, inappropriate code stroke activation may delay imaging of other patients with critical conditions. As the code stroke process is time consuming and involves multiple medical staff, it may also limit the volume of services provided to other patients.
Conclusions Due to these potential costs and harms, inappropriate code stroke activation should be minimised, while still appropriately and swiftly detecting and treating patients requiring hyperacute stroke intervention. Ongoing quality improvement processes may include auditing of inappropriate code strokes and follow-up education.
Reference
Gomez C, Malkoff M, Sauer C, Tulyapronchote R, Burch C, Banet G. Code stroke. An attempt to shorten inhospital therapeutic delays. Stroke. 1994;25:1920–3.
