scholarly journals Administrative Data Linkage to Evaluate a Quality Improvement Program in Acute Stroke Care, Georgia, 2006–2009

2015 ◽  
Vol 12 ◽  
Author(s):  
Moges Seyoum Ido ◽  
Rana Bayakly ◽  
Michael Frankel ◽  
Rodney Lyn ◽  
Ike S. Okosun
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Administrative Data ◽  
Data Linkage ◽  
Stroke Care ◽  
Quality Improvement Program ◽  
Acute Stroke Care ◽  
Improvement Program

Abstract 20: Acute Stroke Care and Thrombolysis at Critical Access Hospitals in Illinois

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Robin Hamann ◽  
Kathleen O’Neill ◽  
Michelle Gardner ◽  
Peggy Jones
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Stroke Care ◽  
The United States ◽  
Critical Access Hospitals ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Intravenous Tissue Plasminogen Activator

Background: Critical access hospitals (CAH) are the first point of stroke care in many rural regions of the United States (US). The Illinois Critical Access Hospital Network (ICAHN), a network of 51 CAH in Illinois, began a quality improvement program to address acute stroke care in 2009. We evaluated the performance on several metrics in acute stroke care at CAH between 2009 and 2011. Methods: Currently, 28 of 51 CAHs in Illinois currently participate in the American Heart Association’s Get With The Guidelines - Stroke (GWTG-S) registry for quality improvement. The GWTG-S registry captured elements including demographics, diagnosis, times of arrival, imaging completion, and intravenous tissue plasminogen activator (IV tPA) administration, and final discharge disposition. We analyzed the change in percent of stroke patients receiving tPA, door-to-needle (DTN) time, and proportion of total stroke patients admitted versus transferred to another facility over the 3 years. Fisher’s exact and Mann-Whitney tests were used as appropriate. Results: In the baseline assessment (2009), there were 111 strokes from 8 sites which grew to 12 sites and 305 strokes in year 1 (2010) and 14 sites and 328 strokes in year 3 (2011). The rate of tPA use for ischemic stroke was 2.2% in 2009, 4.0% in 2010, and 6.2% in 2011 (P=0.20). EMS arrival (41.1%), EMS pre-notification (82.6%), door-to-CT times (median 35 minutes; 34.6% < 25 minutes), and DTN times (average 93 minutes; 13.3% DTN time < 60 minutes) were not different over time. The rate of transfer from CAH to another hospital (51.3%) was constant. Every patient that received tPA except 1 (96.9%) was transferred (drip-ship) for post-tPA care. Conclusions: Improving acute stroke care at CAHs is feasible and represents a significant opportunity to increase tPA utilization in rural areas. As stroke systems develop, it is vital that CAHs be included in quality improvement efforts. The ICAHN stroke collaborative provided the opportunity to coordinate resources, share best practices, participate in targeted educational programming, and utilize data for performance improvement through the funded GWTG-S registry.

Abstract 2197: Telestroke: Optimizing Access to Emergency Interventions in Acute Stroke Care

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Rayetta Johnson
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Health Care Providers ◽  
Positive Impact ◽  
Medical Center ◽  
Stroke Care ◽  
Nurse Specialist ◽  
Care Providers ◽  
Acute Stroke Care ◽  
Evidenced Based

Background and Issues: The burden of stroke in North Carolina is one of the highest in the nation (approximately 28,000 stroke hospitalizations from 2003-2007). The number and high costs of stroke have made it incumbent to improve the numbers of patients receiving effective treatment. There are two major barriers for treatment of acute stroke: time and access. The utilization of telestroke in community hospitals aids in decreasing these barriers by providing immediate access to a stroke neurologist. In order for telestroke to be successful, awareness and education regarding acute stroke care must be provided for health care providers as well as the communities. Thus, the development of a telestroke system requires nursing and medical expertise. The Primary Stroke Center Team at Wake Forest Baptist Medical Center in Winston-Salem, N.C. implemented a telestroke network system (Intouch's Health's RP-7 Robotic system) in January of 2010 to provide 24/7 access to the medical center's acute stroke experts and the latest advancements in stroke interventions. There are eight hospitals in the network at the present time. Methods: Our team identified that many of the network hospital's staff are not experienced in taking care of a stroke patient and that a “roadmap” is useful to guide them in these steps.The stroke nurse specialist developed a quality improvement plan for the network hospitals which included: an evidence-based algorithm for patient care; stroke education, in particular, neurological assessment and tPA administration classes for the ED staff; quarterly meetings to provide outcome and feedback data with each network hospital; stroke awareness events for the community. Mock telestroke consults were also performed prior to “going live” with telestroke for each of the network hospitals. Of utmost importance is the early involvement and education of the EMS system in the respective county of the network hospital. The buy-in of EMS was found to be a key component in the success of the network. Finally, attention to customized quality improvement efforts for each of the facilities are required to accomplish integration into the telestroke network. Results: The data has been analyzed, and thus far, a 24% rate of tPA administration has been seen with our network hospitals (an increase from the 3.6% national average). Comparisons between each of the eight network hospitals' rates of administration of tPA prior to and after joining the network show a trend of increase (10%-40%). The effectiveness of the algorithm has also been explored by analysis of feedback and initial results have shown a positive impact. Conclusion: A combination of improving access to stroke neurologists in conjunction with a focus on improving the level of care via evidenced based stroke care teaching and implementation of algorithms at a network hospital is required for implementing and building a successful telestroke network.

scholarly journals Ongoing Improvement in Acute Ischemic Stroke Therapy Per Concurrent Guidelines and Easily Implementable Quality Improvement Protocol

2021 ◽  
Vol 8 (6) ◽  
pp. 01-09
Author(s):  
Wengui Yu
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Linear Regression Models ◽  
Stroke Therapy ◽  
Acute Stroke Care ◽  
Stroke Registry ◽  
Intravenous Tissue Plasminogen Activator

Background: Despite proven efficacy of intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) in acute ischemic stroke, there has been slow administration of these therapies in the real world practice. We examined the ongoing quality improvement in acute stroke care at our comprehensive stroke center. Methods: Consecutive patients with acute ischemic stroke from 2013 to 2018 were studied. Patients were managed using Code Stroke algorithm per concurrent AHA guidelines and a simple quality improvement protocol implemented in 2015. Demographics and clinical data were collected from Get-With-The-Guideline-Stroke registry and electronic medical records. Patients were divided into 3 groups per admission and implementation date of quality improvement initiatives. Quality measures, including rates of intravenous tPA and EVT, door-to-needle (DTN) time, and door-to-puncture (DTP) time, were analyzed with general mean linear regression models and Jonckheere-Terpstra test. Results: Of the 1,369 eligible patients presenting within 24 hours of symptom onset or wakeup stroke, the rate of intravenous tPA was 20%, 30% and 22%, respectively, in 2013-2014, 2015-2016, and 2017-2018. In contrast, EVT rate was 9%, 14% and 15%, respectively. Based on Jonckheere-Terpstra test, there was significant ongoing improvement in the median DTN time (57, 45, 39 minutes; p < 0.001) and DTP time (172, 130, 114 minutes; p =0.009) during the 3 time periods, with DTN time ≤ 60 and ≤45 minutes in 80% and 63% patients, respectively, in 2017-2018. Conclusions: Getting with the guidelines and simple quality improvement initiatives are associated with satisfactory rates of acute stroke therapy and ongoing improvement in door to treatment times.

Abstract T P206: An Executable Graphical Model for In Silico Prototyping of Processes for Acute Stroke Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
David Norris ◽  
Drew G Levy
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
In Silico ◽  
Graphical Model ◽  
Systems Of Care ◽  
Stroke Care ◽  
Care Process ◽  
Quality Improvement Initiative ◽  
Acute Stroke Care ◽  
Neurologic Outcomes

Background: Strong evidence shows neurologic outcomes in acute ischemic stroke (AIS) worsen with delay from symptom onset to thrombolytic therapy. Yet this onset-to-treatment (OTT) time has not decreased in most systems of care over the past decade. Even the in-hospital, “door-to-needle” (DTN) component of this delay is unimproved, notwithstanding exceptions in institutions where innovative quality improvement efforts have borne fruit. Objective: Provide a basis for visualizing, communicating, and simulating stroke care system configuration and performance to facilitate the quality improvement efforts necessary for reducing DTN and OTT times in AIS. Methods: We developed an executable, graphical model of acute stroke care, employing the hierarchical colored Petri net (CPN) formalism. The top level of the hierarchy sets the epidemiologic context, including demographics and background processes like stroke prevention and onset. At deeper levels, we elaborate time-critical processes that contribute to OTT: stroke recognition, EMS activation and transport, and many emergency department (ED) processes. Key ED innovations described in the literature were modeled: EMS prenotification, a direct-to-imaging transport strategy, process parallelism, and telestroke capability. Results: Our CPN model has provided a platform for detailed, realistic prototyping and simulation of acute stroke care processes. The performance characteristics of process configurations with multiple, interacting innovations were evaluated and compared. Conclusions: In silico care process prototyping permits evaluation of proposed innovations in simulated settings. Using an intensively graphical simulation modeling methodology adds value by promoting “visual consensus” regarding care process structure and function, among stakeholders in a quality improvement initiative.

Abstract T P351: Stroke Care Team Associations with Acute Stroke Quality Improvement in Veterans Healthcare Administration

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Teresa M Damush ◽  
Zhangsheng Yu ◽  
James Slaven ◽  
Virginia Daggett ◽  
Danielle Sager ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Guideline Adherence ◽  
Stroke Care ◽  
Early Response ◽  
Quality Data ◽  
Late Response ◽  
Acute Stroke Care ◽  
Care Services ◽  
Organizational Constructs

Background and Objective: We conducted standardized semi-structured baseline interviews to understand organizational constructs of stroke teams on a composite, acute stroke quality indicator across 11 VA Medical Centers (VAMCs). Methods: We conducted 104 semi-structured, in person, baseline interviews with clinical providers of acute stroke care services. Respondents were from nursing, emergency medicine, neurology, rehabilitation, inpatient care, medicine and quality management. We audiotaped the interviews, transcribed verbatim, and de-identified the data. Data were qualitatively coded using Nvivo software to tag segments of text into meaningful units based upon our Facilitating Best Practices Framework. Coders met regularly to review and consolidate emergent themes. Additionally a standardized team of chart abstractors collected 10 acute stroke quality indicators from a central location which comprised the composite. The follow up period included 6 (early response) and 12 (late response) months after a stroke collaborative. Results: At baseline, the VAMCs with a higher proportion of its respondents reporting regular monthly communication about stroke were associated with a late response in stroke quality improvement while sites with a lower proportion reporting regular monthly communication were associated with an early response in quality. VAMCs reporting the use of a designated nurse to promote guideline adherence and disease management were associated with an early response in quality. VAMCs reporting tracking their quality data and providing feedback to clinicians were associated with an early and late response in stroke quality improvement compared to those who did not. Finally, sites reporting the timely detection of acute stroke in the Emergency Department as a barrier at baseline were associated with no improvement in stroke quality. Conclusion: Our data suggests that clinical teams that wish to improve their quality may redesign their organization of care as structured to communicate regularly among their team, utilize nurses as designated for guideline adherence, track their quality data and provide feedback to clinicians, and triage presenting strokes in a timely manner. Funded by VA HSRD QUERI SDP #09-105

scholarly journals Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care

Stroke ◽  
2019 ◽  
Vol 50 (6) ◽  
pp. 1525-1530 ◽  
Author(s):  
Dominique A. Cadilhac ◽  
Rohan Grimley ◽  
Monique F. Kilkenny ◽  
Nadine E. Andrew ◽  
Natasha A. Lannin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Before And After

Abstract 303: A Novel Multi-modal Approach to Stroke Care Quality Improvement and The Development of High-performing Stroke Care Teams

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Mark O Loveless ◽  
Aaron Kamauu
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Path Analysis ◽  
Clinical Outcomes ◽  
Critical Path ◽  
Stroke Care ◽  
Care Quality ◽  
Care Team ◽  
Care Process ◽  
Acute Stroke Care

Background: The clinical outcomes and quality of care in acute ischemic stroke (AIS) are time-dependent and influenced by the effectiveness and efficiency of the care delivery system. Much attention has been given to improving process and procedure; however, the structure and inter[[Unable to Display Character: &#8208;]]dependencies of the stroke care teams must be integrated into any acute stroke care quality improvement process. Objective: The objective of this study was to apply an innovative multi[[Unable to Display Character: &#8208;]]modal analytic approach that combines formal epidemiologic analysis, process evaluation and social network modeling of stroke care teams to describe and improve the critical system characteristics of high[[Unable to Display Character: &#8208;]]performing units in real[[Unable to Display Character: &#8208;]]world hospital systems. Methods: Characteristics of individual hospital units, as well as variation of treatment delivery, were analyzed and compared. A critical path analysis was created based on a widely adopted acute stroke care process model. Stroke care team structures and inter[[Unable to Display Character: &#8208;]] dependencies were mapped based on the responses to a survey and the responses were analyzed using open[[Unable to Display Character: &#8208;]]source network graphing software. Results: The care team networks were overlaid on to the corresponding process pathways to create a final synthesis of the process and team structure (example below). Critical path analysis combined with mapping of the individual stroke team network interactions demonstrated additional associations between the team structures and process/clinical outcomes. Opportunities for improvement in both process and personnel organization were identified and integrated into existing CQI efforts. Conclusion: Multi[[Unable to Display Character: &#8208;]]modal systems analysis incorporating both care process and stroke care team inter[[Unable to Display Character: &#8208;]]dependencies offers an enhanced approach to integrated quality improvement for acute stroke care.

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