Date of Graduation

Fall 12-18-2026

Document Access

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

MSN project

First Advisor

Cynthia Huff DNP RN OCN CRNI CNL

Abstract

Problem: Stroke outcomes are highly time-dependent, and rapid neuroimaging is required to guide treatment decisions. Prior to this project, no standardized nursing workflow existed to guide pre-imaging tasks in this emergency department (ED), contributing to variable and often delayed door-to-CT (DTC) times. Context: This project was conducted in a 16-bed ED within a community-based medical center in Northern California pursuing Primary Stroke Center certification, which averages two to three suspected stroke presentations per week. Interventions: A nurse-initiated stroke alert protocol was implemented alongside a standardized bedside pre-CT workflow checklist and a team-based parallel processing model in which pre-imaging tasks were distributed across a primary registered nurse (RN), a secondary RN, and support staff. Measures: The primary outcome measure was median DTC time. Process measures included time to stroke alert activation, time to intravenous (IV) access, time to point-of-care glucose testing, and checklist compliance rate. Balancing measures included ED length of stay, staff workload perception, and CT scanner wait times for non-stroke patients. Results: Over a 12-week, PDSA-guided implementation, median DTC time decreased from a pre-intervention baseline of 26 minutes to a post-implementation median of approximately 13 to 15 minutes, meeting the project's specific aim. Checklist compliance rose from 61% to 94% across PDSA cycles, and no adverse changes were observed in balancing measures. Conclusions: A low-cost, nurse-driven standardized workflow can reliably and sustainably reduce door-to-CT time in a resource-constrained emergency department, supporting improved patient outcomes and progress toward stroke center certification.

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