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  • 1. NEUROSCIENCE SERVICE LINE TEAM STROKE Core Team: Leslie Barna, RN, MSN Jose Biller, MD Barbara Buturusis, RN, MSN Linda Chadwick, RN, BSN Rima Dafer, MD Ann Hahn Mary Healey, RN, BS Lisa Millsap, PharmD, ACNP Michael Schneck, MD Staff of 2NE, 2W and Telemetry Admitting Center for Clinical Effectiveness Center for Home Care & Hospice Clinical Neurodiagnostic Laboratory Education and Support Services Emergency Department Human Resources/Organizational Development Interventional Radiology Laboratory Marketing Medical Records Neurosurgery Nutrition Pastoral Care Primary Care Psychiatry Rehabilitation Services Social Work
  • 2. NEUROSCIENCE SERVICE LINE TEAM STROKE Project Aim Statement  To standardize and improve care for acute stroke and transient ischemic attack (TIA) patients from the time the patient has stroke symptoms through the rehabilitation phase.  To achieve JCAHO Disease Specific certification for the Stroke program by demonstrating compliance with standards and Brain Attack Coalition guidelines for stroke care. PLAN
  • 3. NEUROSCIENCE SERVICE LINE TEAM STROKE How the Stroke Program Monitors and Improves Quality  “Get with the Guidelines” On - Line Patient Management Tool  Using Plan, Do, Study, Act we pursue 100% compliance with:  JCAHO 1 DVT Prophylaxis  JCAHO 2 Discharge on Anti-Thrombotics  JCAHO 3 A. Fib. Patients Discharged on Anticoagulants  JCAHO 4A rt - PA Considered and Documented  JCAHO 4B rt - PA Administered – when appropriate  JCAHO Disease Specific Standards  Stroke Program Guidelines
  • 4. NEUROSCIENCE SERVICE LINE TEAM STROKE Implemented evidence based clinical guidelines and standard orders for stroke care Initiated a Stroke Immediate Response Team (pager 14911) Initiated Stroke patient database and analyzed results Standardized Neurology H & P and progress note Daily multidisciplinary rounds 10 Acute or Preventive Stroke Clinical Trials DO – Solutions Implemented
  • 5. NEUROSCIENCE SERVICE LINE TEAM STROKE Pre ED and ED Team Begins in the Community; Ends with ED discharge •Stroke Education Program (e-learning) •Rapid Response - Lab Analysis •Rapid Response - Radiology CT •Code Red -Elevated Triage Level •Implemented Clinical Trials Pre ED and ED Team Begins in the Community; Ends with ED discharge •Stroke Education Program (e-learning) •Rapid Response - Lab Analysis •Rapid Response - Radiology CT •Code Red -Elevated Triage Level •Implemented Clinical Trials Acute Team Begins with Hospital admission; Ends with Hospital discharge •Opened Acute Stroke Unit •Global nursing education •Standardized order sets •Stroke Guidelines Acute Team Begins with Hospital admission; Ends with Hospital discharge •Opened Acute Stroke Unit •Global nursing education •Standardized order sets •Stroke Guidelines Rehab Team Begins with Hospital admission; Ends with Rehab discharge •Daily Multidisciplinary Rounds •Rehab Level of Care criteria •Weekend therapy sessions •Neuro Therapy Team - consistency of therapists Rehab Team Begins with Hospital admission; Ends with Rehab discharge •Daily Multidisciplinary Rounds •Rehab Level of Care criteria •Weekend therapy sessions •Neuro Therapy Team - consistency of therapists Stroke Prevention Team Coordination of professional and community education •Stroke Month Activities: Staff & management education, Stroke Screening and Risk Factor Assessment •Smoking Cessation Classes •Stroke Support Group •Power to End Stroke in African American Community (May 06) •Community Television Ad (Spring 06) •Web Site Development •Patient Education Standardization Stroke Prevention Team Coordination of professional and community education •Stroke Month Activities: Staff & management education, Stroke Screening and Risk Factor Assessment •Smoking Cessation Classes •Stroke Support Group •Power to End Stroke in African American Community (May 06) •Community Television Ad (Spring 06) •Web Site Development •Patient Education Standardization DO – Design & Implement Team Structure
  • 6. NEUROSCIENCE SERVICE LINE TEAM STROKE 1. Patients with ischemic stroke (non-ambulatory) received DVT prophylaxis by Day 2 Since May 2005, the team achieved 100% STUDY Percent January 2005 - December 2005 Month 01/05 02/05 03/05 04/05 05/05 06/05 07/05 08/05 09/05 10/05 11/05 12/05 40 60 80 100 120 140 160 UCL = 117.82 Mean = 94.95 LCL = 72.08
  • 7. NEUROSCIENCE SERVICE LINE TEAM STROKE 2. 100% of patients with acute ischemic stroke or TIA received antithrombotic therapy within 48 hours of admission STUDY Percent January 2005 - December 2005 Month 01/05 02/05 03/05 04/05 05/05 06/05 07/05 08/05 09/05 10/05 11/05 12/05 99.990 99.995 100.000 100.005 100.010 3. 100% of patients with acute ischemic stroke or TIA and atrial fib. were discharged on anticoagulants Percent January 2005 - December 2005 Month 01/05 02/05 03/05 04/05 05/05 06/05 07/05 09/05 10/05 11/05 99.990 99.995 100.000 100.005 100.010
  • 8. NEUROSCIENCE SERVICE LINE TEAM STROKE 4. Patients with ischemic stroke who present to the hospital within 3 hours of symptom onset are: a. Considered for rt-PA b. Receive rt-PA if indicated Team working to improve Team working on meeting criteria documentation in all clinical settings STUDY Percent January 2005 - December 2005 Month t 01/05 04/05 05/05 06/05 07/05 09/05 10/05 11/05 12/05 0 50 100 150 200 UCL = 139.19 Mean = 68.57 LCL = 0.00 Percent January 2005 - December 2005 Month 05/05 06/05 07/05 11/05 12/05 20 40 60 80 100 120 140 160 180 UCL = 159.16 Mean = 88.89 LCL = 18.62
  • 9. NEUROSCIENCE SERVICE LINE TEAM STROKE  Monitor compliance with JCAHO standards and quality indicators and continue to improve documentation  Customize Stroke patient education tool  NIH Stroke Scale Certification  Ongoing staff education  Continue and expand community outreach targeting high risk populations  Promote consistent utilization of stroke guidelines and order sets for off service patients  Increase the number of participants in clinical trials  Submit JCAHO intra-cycle report including measures of success (January 2007) ACT – Next Steps
  • 10. NEUROSCIENCE SERVICE LINE TEAM STROKE Achieved the first JCAHO Disease Specific Certification at LUHS Standardized stroke care and improved quality Initiated program of clinical trials Established engaged, interdisciplinary cross-continuum teams Secured capital funding and initiated Acute Stroke Unit Received LUHS Leadership Award ACCOMPLISHMENTS