In the Sacramento Emergency Department (ED), nurses lead evidence-based improvements that enhance patient safety and outcomes. In 2025, an interdisciplinary ED team led by Anna Moiseyenko, BSN, RN, with nurses Leslie Keear, BSN, RN; Geanina Copaciu, RN; Christine Swanson, BS, RN; Carri Carson, MBA, BSN, RN; and ED Assistant Director, Jason Murray, Stroke Coordinator, Jamil Bitar, MD; and Jonathan Hartman, MD, identified a critical gap in stroke recognition among patients presenting with dizziness.

Traditionally, dizziness was not seen as a hallmark sign of stroke and was often attributed to benign conditions such as vertigo, dehydration, or inner-ear dysfunction. However, research shows that posterior circulation strokes, which affect the cerebellum and brainstem, often present with dizziness or imbalance as the only symptom. Patients with posterior strokes also face a higher risk of delayed diagnosis and long-term disability compared to those with anterior circulation strokes.

Recognizing this, Moiseyenko and the team developed and implemented a standardized process for assessing and managing patients with dizziness. The initiative included a Dizziness Assessment Algorithm to help ED staff determine when dizziness might signal a potential stroke, with specific steps for timely imaging, consultation, and stroke alert activation.

Nurses were trained through huddles and peer coaching to apply the algorithm consistently. Chart audits evaluated compliance and outcomes, ensuring the new process improved recognition and response times. The team also worked closely with ED physicians, neurology, and neurointerventional radiology to ensure rapid coordination once a potential stroke was identified.

Since implementation, 380 patients with dizziness were screened using the new algorithm. Of these, 7 patients (2%) were diagnosed with stroke, patients who might have been missed under traditional screening criteria. Stroke Alert process was activated and appropriate interventions performed in a timely manner. This data underscores the algorithm’s value in supporting early detection and intervention for atypical stroke presentations.

“This project demonstrates how nurses turn evidence into action,” said Carri Carson, MBA, BSN, RN, Assistant Director of Emergency Services. “By standardizing assessment and empowering staff with knowledge, we’re improving recognition, response, and outcomes for our patients.”

Through evidence-based practice, collaboration, and innovation, the ED team turned a simple symptom into a life-saving opportunity.