Date of Award


Document Type



College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Annette Thomas


Janiece DeSocio


Posterior circulation strokes are often missed in emergency departments due to atypical symptom presentation that leads to poor prognosis and increased medical costs related to treatment. The purpose of this project is to increase identification of posterior circulation strokes by providing an educational tool and introducing a revised stroke assessment tool that includes symptoms caused by posterior circulation strokes. Success of project implementation was measured by improved test scores of post education and post intervention questionnaires, increased use of the BE-FAST assessment tool, increased completed MRIs, and an increase in the number of confirmed posterior circulation strokes. This multi-part quality improvement project occurred in a level IV emergency department and focused on enhancing registered nurses' awareness of atypical symptom presentation due to neurological etiologies. Approximately 36% (n = 18) registered nurses participated in this project and 33% (n = 6) of those nurses completed both questionnaires. The second part of this project encompassed retrospective and prospective chart review looking at chief complaints, whether an MRI was completed, final diagnosis, and if there was a correlation between utilization of BE-FAST assessments and posterior circulation stroke diagnosis. There were 130 charts that met criteria for review. Chi square test of independence showed no statistical significance of BE-FAST assessment with posterior stroke (p > 0.05): however, there was a statistical significance between MRIs completed and a diagnosis of a posterior stroke (p < 0.05). Further studies with a longer implementation time, improved disbursal method, and easier shortcut to recalling smart phrase is recommended to further evaluate the efficacy of implementing a BE-FAST assessment for patients presenting with neurological symptoms in healthcare settings.