stroke

1. ©2016 The Advisory Board Company advisory.com
1
Stroke Protocols Ensure Efficient Patient Intake, Diagnosis, Treatment
Utilize Data Metrics to Continually Evaluate Protocol Efficiency with Stroke Response Team
Stroke Protocols
Source: Service Line Strategy Advisor research and analysis
EMS pre-alert sent
to ED and stroke
response team
Patient immediately evaluated
for stroke with blood tests and
relevant diagnostic imaging
On-call neurologist
makes diagnosis and
outlines treatment plan
IV-tPA administered (if
applicable), patient
monitored for improvement
Neurointerventional
treatment conducted (if
applicable)
Pre-discharge care and
patient education
provided
Sample Stroke Care Pathway
Advisory Board’s Tips for Implementation
1
• Outline specific needs from clinicians and administrators at each step throughout care
pathway
• Only utilize staff when necessary to maximize physician and program capacity
Action
Steps
Streamline Staff Involvement
2
• Develop and distribute stroke alert protocol sheets or notecards to all relevant stakeholders
as a readily accessible resource
• Notify local EMS and staff across the hospital who may encounter stroke patients of
protocols to ensure standardization and streamline patient entry
Action
Steps
Clearly Communicate Steps
3
• Track program and care quality data metrics across care pathway to measure success
• Work with stroke team to set specific goals for quality improvement and track program
progress in reaching goals
Action
Steps
Set Goals for Quality Improvement

2. ©2016 The Advisory Board Company advisory.com
2
Rising Focus on Care Continuity Driving Need for Rigorous Patient Follow-Up
Post-Discharge Care, Post-Acute Transitions Necessary to Bring Down Readmission Rates
Stroke Protocols
Source: Andersen, HE et al., Can Readmission After Stroke Be Prevented? : Results of a Randomized Clinical Study: A Post-
discharge Follow-Up Service for Stroke Survivors. Stroke, 2000, 31: 1038-1045. Bravata et al., Readmission and Death After
Hospitalization for Acute Ischemic Stroke: 5-Year Follow-Up in the Medicare Population, Stroke 2007; 38: 1899-1994. Service
Line Strategy Advisor research and analysis.
1) Condon, C., Lycan, S., Duncan, P. & Bushnell, C. “Reducing Readmissions after Stroke
With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program,”
(2016). Stroke,
Intensive Follow-Up Care Capable of Reducing Readmissions
Pre-Discharge Education
 Outline care plan for any
necessary post-acute services
 Educate in lifestyle changes to
prevent further vascular disease
 Provide guidance in tackling
potential further complications
that may arise
Patient Follow-Up
 Call patient 30-days post-
discharge to follow-up
 Provide medical examinations in
days, months following discharge
if necessary
 Give patient continuing education
in preventing stroke readmission
Post-Discharge Coordination
 Work with relevant post-acute
providers to create long-term
care plan
 Coordinate long-term plan to
prevent readmission
 Relevant documents sent to
post-acute provider or PCP for
continual medical management
Reduction in 30-day
readmission associated with
nurse practitioner led follow-
up visit versus no follow-up
visit1
48%
Study In Brief: Stroke Readmission Prevention1
• Randomized clinical study found regimented in-person follow-up visits
significantly reduced readmissions for those patients discharged home
• Patients who received a phone call within one week of discharge were
more likely to attend a follow-up visit
• The study utilized nurse practitioners trained in a specific post-discharge,
demonstrating the importance of a regimented, standardized follow-up
protocol that can be employed by any practitioner on the stroke team

3. ©2016 The Advisory Board Company advisory.com
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Strategic Guidance
Set Criteria, Pathways Key to Post-Acute Relationship
Post-Acute Transitions
1) Pseudonym
In anticipation of the effects of
health reform, hospitals are
beginning to look towards building
relationships with post-acute care
providers in order to deliver the
best experience and quality of care
for patients.
Programs are working to develop
formalized referral relationships
with hospitals, in which
standardized discharge criteria and
pathways are developed. Certain
programs, such as the one profiled,
are placing rehabilitation specialists
in the acute-care setting to ease the
transition to post-acute care and
ensure proper triage to
rehabilitation providers.
The last key towards building
relationships between acute and
post-acute providers is data and
outcomes sharing. Acute-care
providers must share pre-discharge
functionality measurements, and
pre-surgical measurements when
applicable. Similarly, post-acute
providers must provide
rehabilitation outcomes data with
referring programs for proper
follow-up. This is important for
maintaining trust that the programs
physicians refer patients to are
continuing to provide proper care.
Keys to Successful Post-
acute Relationships:
!
• Established list of internal or
external post-acute providers,
depending on availability
• Set criteria for discharge to each
level of post-acute care
• Individuals appointed to ease
transition to post-acute setting
• Data and outcomes sharing
between acute and post-acute
providers
Inpatient Rehab
Facility
Skilled Nursing
Facility
Outpatient Clinics Home Health
Case in Brief: Everwood Rehab
• Physical medicine and rehabilitation hospital in Midwestern U.S. offering a range of
specialties
• Selected rehabilitation physicians and APs work in acute-care setting to provide
consults, enhance relationship with acute care providers, and ease transition into
post-acute care setting
• Surgical and acute-care outcome measurements shared with post-acute providers
• Post-acute outcomes data provided to case stakeholders for follow-up and tracking
Acute-care
Providers