Abstract 18789: A Learning Collaborative Model to Improve Door to Needle Time for Stroke Thrombolysis in Chicago

Background: Door-to-needle (DTN) times have remained suboptimal despite overall increases in tissue plasminogen activator use (tPA) for stroke in Chicago. The American Heart Association’s (AHA) Quality Enhancement for Speedy Thrombolysis in Stroke (QUESTS) initiative aimed to identify barriers to reduce DTN times at Chicago’s 15 primary stroke centers (PSCs) and increase the proportion of patients treated with tPA within 60 minutes of hospital arrival. Methods: Starting in January 2013, we used face-to-face and on-site meetings with each PSC’s stroke team members to share AHA Target Stroke best practices and strategies to reduce DTN time. A survey of current practice was completed at each site to determine opportunities for improvement and repeated at 1 year to assess implementation of new strategies. We used the Get With The Guidelines (GWTG) Stroke registry to aggregate baseline data DTN times and track performance in each quarter of 2013. Results: At baseline, 5 strategies were notably under-utilized at Chicago’s 15 PSCs: 1) Direct to CT scanner (baseline: 0 sites; 1 year: 5 sites); 2) pre-mixing tPA (baseline: 1 site; 1 year: 14 sites); 3) tPA prior to laboratory results (baseline: 3 sites; 1 year: 7 sites); 4) stroke code activation at triage (baseline: 4 sites; 1 year: 13 sites); and 5) streamlined consent process (baseline: 0 sites; 1 year: 12 sites. The proportion of patients treated within 60 minutes increased in each quarter of 2013 from 25% in quarter 1 to 60% in quarter 4 (p<0.01). The median DTN time decreased from 89.5 minutes in quarter 1 to 55 minutes in quarter 4 (p<0.01). Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 15 PSCs in Chicago, we observed major improvements within a few months. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract 218: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.218 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Shyam Prabhakaran ◽

Renee M Sednew ◽

Kathleen O’Neill

Keyword(s):

Best Practices ◽

Performance Improvement ◽

Best Practice ◽

Learning Collaborative ◽

Collaborative Model ◽

Stroke Registry ◽

Chicago Area ◽

Regional Collaboration ◽

Content Expert ◽

And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract TMP68: Expanding a Learning Collaborative Model in Chicago to Improve Door to Needle for Stroke Thrombolysis: Raising the Bar

Stroke ◽

10.1161/str.48.suppl_1.tmp68 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Shyam Prabhakaran ◽

Renee M Sednew ◽

Kathleen O’Neill

Keyword(s):

Best Practices ◽

Performance Improvement ◽

Best Practice ◽

Learning Collaborative ◽

Collaborative Model ◽

Stroke Registry ◽

Chicago Area ◽

Regional Collaboration ◽

Content Expert ◽

And Performance

Background: There remains significant opportunities to reduce door-to-needle (DTN) times for stroke despite regional and national efforts. In Chicago, Quality Enhancement for the Speedy Thrombolysis for Stroke (QUESTS) was a one year learning collaborative (LC) which aimed to reduce DTN times at 15 Chicago Primary Stroke Centers. Identification of barriers and sharing of best practices resulted in achieving DTN < 60 minutes within the first quarter of the 2013 initiative and has sustained progress to date. Aligned with Target: Stroke goals, QUESTS 2.0, funded for the 2016 calendar year, invited 9 additional metropolitan Chicago area hospitals to collaborate and further reduce DTN times to a goal < 45 minutes in 50% of eligible patients. Methods: All 24 hospitals participate in the Get With The Guidelines (GWTG) Stroke registry and benchmark group to track DTN performance improvement in 2016. Hospitals implement American Heart Association’s Target Stroke program and share best practices uniquely implemented at sites to reduce DTN times. The LC included a quality and performance improvement leader, a stroke content expert, site visits and quarterly meetings and learning sessions, and reporting of experiences and data. Results: In 2015, the year prior to QUESTS 2.0, the proportion of patients treated with tPA within 45 minutes of hospital arrival increased from 21.6% in Q1 to 31.4% in Q2. During the 2016 funded year, this proportion changed from 31.6% in Q1 to 48.3% in Q2. Conclusions: Using a learning collaborative model to implement strategies to reduce DTN times among 24 Chicago area hospitals continues to impact times. Regional collaboration, data sharing, and best practice sharing should be a model for rapid and sustainable system-wide quality improvement.

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Abstract TP313: A Metro Chicago Learning Collaborative Model to Improve Smoking Cessation Rates in Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.tp313 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Zachary Bulwa ◽

Joy Rainey ◽

Donna Kruse ◽

Lynn Klassman ◽

Renee Sednew ◽

...

Keyword(s):

Smoking Cessation ◽

Best Practices ◽

Smoking Behavior ◽

Learning Collaborative ◽

Stroke Patients ◽

Post Discharge ◽

Collaborative Model ◽

Chicago Area ◽

History Of ◽

Get With The Guidelines

Background: National guidelines for stroke care recommend that patients discharged with a stroke who have a history of smoking receive smoking cessation intervention prior to hospital discharge. However, less is known about the types of intervention provided and subsequent outcomes post-discharge. The Metro Chicago Smoking Cessation Initiative Pilot aimed to improve understanding of smoking cessation interventions provided at discharge, smoking behavior at 30 days post-discharge, and best practices and barriers for reducing smoking rates in stroke patients discharged from 20 Chicago area hospitals. Methods: A review of smoking cessation interventions provided at discharge and smoking cessation outcomes post-discharge for stroke patients discharged between August 1, 2018 and July 31, 2019 at 20 Chicago area participating hospitals was conducted using Get With The Guidelines® Stroke. The pilot used a Learning Collaborative model that included a quality improvement leader, smoking cessation/health behavior content experts, reporting of experiences and data, and sharing of best practices. All hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Results: Preliminary results from the 20 participating hospitals suggest smoking cessation counseling is the most commonly delivered intervention at discharge. Of the patients reached at 30 days post-discharge, 75% of those who reported at history of smoking at the time of their stroke were still using tobacco products. However, nearly 50% of those patients reported having made at least one attempt to quit. Conclusions: Preliminary results from this pilot project highlight the need for improved tracking of smoking cessation interventions provided at discharge and associated smoking behavior post-discharge, as well as the benefits of regional collaboration for identifying and implementing best practices.

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Abstract TP385: Using a Learning Collaborative Model in Metro Chicago to Identify Best Practice Strategies for Emerging Topics: E-Cigarette Use in Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.tp385 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Renee Sednew ◽

Zachary Bulwa ◽

Joy Rainey ◽

Donna Kruse ◽

Lynn Klassman ◽

...

Keyword(s):

Smoking Cessation ◽

Best Practices ◽

Cigarette Use ◽

National Guidelines ◽

Learning Collaborative ◽

Post Discharge ◽

Collaborative Model ◽

Current Smoking ◽

Cessation Intervention ◽

Emerging Topics

Background: While learning collaborative models have been shown to aid implementation of published national guidelines, less is known about their role in informing health care providers about emerging topics not yet written into guidelines. National guidelines state that stroke patients who have a history of smoking should receive smoking cessation intervention prior to hospital discharge. However, guidelines do not include recommendations related to e-cigarette use. Launched July 2018, the Metro Chicago Smoking Cessation Initiative was a one-year pilot aimed at improving understanding of smoking cessation interventions provided at discharge, smoking behavior post-discharge, and best practices for reducing smoking rates at 20 Chicago area hospitals. While hospital practices and patient behavior around e-cigarettes was not an aim, the learning collaborative model enabled hospital participants to report their experiences and enact practice changes related to e-cigarettes. Methods: The pilot used a Learning Collaborative model that included a quality improvement leader, health behavior content experts, reporting of experiences and data, and sharing of best practices. Pilot participating hospitals were required to attend quarterly online learning sessions and use Get With The Guidelines® Stroke for data entry. Hospitals documented smoking cessation intervention provided at time of discharge and contacted patients via phone at 30 days post-discharge to gather data on current smoking use, quit attempts, and therapies used. Hospitals completed a baseline questionnaire reporting current smoking cessation practices and a mid-point questionnaire reporting changes to practice and experiences as a pilot participant. Responses were reviewed for themes related to e-cigarettes. Results: See Table 1 Conclusions: A Learning Collaborative Model may be a method for identifying strategies for practice changes prior to guideline recommendations.

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Abstract 28: Virginia Stroke Coordinators Successfully Collaborate to Improve Door to Needle Times and EMS Relationships

Stroke ◽

10.1161/str.48.suppl_1.28 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Heather Turner ◽

Stacie Stevens ◽

Tiffany McGhee ◽

Donna Doherty ◽

Patricia Lane

Keyword(s):

Best Practices ◽

National Level ◽

Stroke Care ◽

The State ◽

Stroke Team ◽

Shared Information ◽

Working Together ◽

High Level ◽

Get With The Guidelines ◽

Iv Tpa

Background and Issues: The Virginia Stroke Coordinators Consortium (VSCC) was founded in 2009 with a stated goal of striving for high-level evidence based stroke care for all Virginians. Purpose: In CY2015, the VSCC set two specific goals, to improve arrival to IV TPA administration (“Door to Needle”-DTN) times in Virginia and to improve our stroke team relationships with EMS. DTN Time Methods: We shared the Target Stroke Phase 2information and best practices, we regularly shared our own best practices at our monthly meetings (one live meeting per quarter) through formal presentations and informal discussion, we reviewed current journal publications related to decreasing DTN times and we shared information about and encouraged participation in nationally offered webinars on improving arrival to CT and DTN times. DTN Time Results: 29 of the 60 hospitals represented within the VSCC participate in Get with the Guidelines so we used that data as a sample of our work. To measure our success, we compared CY2014 Target Stroke Honor Roll reports to CY2015 for the state of Virginia and saw improvement (beyond the level of improvement seen at the national level) in every measure including percent of ischemic strokes that received thrombolysis, percent of patients with a DTN time of 60m or less and percent of patients with a DTN time of 45m or less (including and excluding patients with documented reasons for delay.) EMS Methods: Again, shared Target Stroke and our own best practices, shared EMS feedback methods and standardized feedback forms, included EMS in our meetings and presentations, encouraged communication with local EMS providers, worked with state wide EMS to develop template for post TPA transport. EMS Results: The VSCC was surveyed in April of 2014(n-34) and again in April 2015(n-31). We saw that the number of coordinators interacting with EMS increased to 100% of respondents, frequency of EMS interaction increased, those with monthly interaction doubled, EMS feedback increased and 48% of respondents felt their relationships with EMS had improved. (43% already felt they had a good relationship.) Conclusion: Working together, Stroke Coordinators can significantly lower door to IV TPA times and improve stroke team relationships with EMS throughout the state.

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Designed Learner Interactions in Blended Course Delivery

Online Learning ◽

10.24059/olj.v15i1.183 ◽

2011 ◽

Vol 15 (1) ◽

Author(s):

Reba-Anna Lee ◽

Brian Dashew

Keyword(s):

Instructional Design ◽

Best Practices ◽

Design Process ◽

Course Delivery ◽

Student Interactions ◽

Face To Face ◽

Instructional Design Process ◽

Hybrid Delivery ◽

Academic Technology ◽

Blended Course

In transitioning to a hybrid delivery model, faculty are presented with an opportunity to engage in a systematic instructional design process which can bring coursework in line with pedagogical best practices that may not exist in traditional face-to-face classes. This paper presents a model whereby Marist College Academic Technology & eLearning staff focuses faculty attention on designing effective student interactions with content, the instructor, and other students. These interactions promote deeper levels of engagement in student learning.

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Prescription in Locker Box (PILBOX): Remodeling of the Medication Collection Process (Preprint)

10.2196/preprints.23266 ◽

2020 ◽

Author(s):

Lim Jit Fan Christina ◽

Goh Boon Kwang ◽

Chee Wing Ling Vivian ◽

Tang Woh Peng ◽

Goh Qiuling Bandy

Keyword(s):

Cross Sectional Study ◽

Ease Of Use ◽

Prescription Medications ◽

Pharmacy Staff ◽

Cross Sectional ◽

Team Members ◽

Face To Face ◽

Ranking Score ◽

Study Team ◽

Willingness To Use

BACKGROUND Traditionally, patients wishing to obtain their prescription medications have had to present themselves physically at pharmacy counters and collect their medications via face-to-face interactions with pharmacy staff. Prescription in Locker Box (PILBOX) is a new innovation which allows patients and their caregivers to collect their medication asynchronously, 24/7 at their convenience, from medication lockers instead of from pharmacy staff and at any time convenient to them instead of being restricted to pharmacy operating hours. OBJECTIVE This study aimed to determine the willingness by patients/caregivers to use this new innovation and factors that affect their willingness. METHODS This prospective cross-sectional study was conducted over 2 months at 2 public primary healthcare centres in Singapore. Patients or caregivers who were at least 21 yo and turned up at the pharmacies to collect medications were administered a self-developed 3-part questionnaire face-to-face by trained study team members, if they gave their consent to participate in the study. RESULTS A total of 222 participants completed the study. About 40% of them participants were willing to use the PILBOX to collect their medications. Amongst the participants who were keen to use the PILBOX service, slightly more than half (i.e. 52.8%) of them were willing to pay for the PILBOX service. The participants felt that the ease of use (3.46±1.21 i.e. mean of ranking score ± standard deviation) of the PILBOX was the most important factor that would affect their willingness to use the medication pick up service. This was followed by “waiting time” (3.37±1.33), cost of using the medication pick up service (2.96±1.44) and 24/7 accessibility (2.62±1.35). This study also found that age (p=0.006), language literacy (p=0.000), education level (p=0.000), working status (p=0.011) and personal monthly income (p=0.009) were factors that affected the willingness of the patients or caregivers to use the PILBOX. CONCLUSIONS Patients and caregivers are keen to use PILBOX to collect their medications for its convenience and the opportunity to save time, if it is easy to use and not costly.

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Organizing and Managing Data Analytics Teams for Procurement

The Oxford Handbook of Supply Chain Management ◽

10.1093/oxfordhb/9780190066727.013.2 ◽

2020 ◽

Author(s):

Benjamin Shao ◽

Robert D. St. Louis

Keyword(s):

Best Practices ◽

Business Strategy ◽

Data Analytics ◽

Team Members ◽

Procurement Process ◽

Using Data ◽

And Training ◽

Different Levels ◽

The Way

Many companies are forming data analytics teams to put data to work. To enhance procurement practices, chief procurement officers (CPOs) must work effectively with data analytics teams, from hiring and training to managing and utilizing team members. This chapter presents the findings of a study on how CPOs use data analytics teams to support the procurement process. Surveys and interviews indicate companies are exhibiting different levels of maturity in using data analytics, but both the goal of CPOs (i.e., improving performance to support the business strategy) and the way to interact with data analytics teams for achieving that goal are common across companies. However, as data become more reliably available and technologies become more intelligently embedded, the best practices of organizing and managing data analytics teams for procurement will need to be constantly updated.

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Telehealth Competencies for Interprofessional Teams Caring for Older Adults and Care Partners

Innovation in Aging ◽

10.1093/geroni/igaa057.2886 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 796-796

Author(s):

Becky Powers ◽

Kathryn Nearing ◽

Studi Dang ◽

William Hung ◽

Hillary Lum

Keyword(s):

Older Adults ◽

Best Practices ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Delivery Of Care ◽

Face To Face ◽

Evaluation Measures ◽

Interprofessional Teams ◽

Care Partners

Abstract Providing interprofessional geriatric care via telehealth is a unique clinical skillset that differs from providing face-to-face care. The lack of clear guidance on telehealth best practices for providing care to older adults and their care partners has created a systems-based practice educational gap. For several years, GRECC Connect has provided interprofessional telehealth visits to older adults, frequently training interprofessional learners in the process. Using our interprofessional telehealth expertise, the GRECC Connect Education Workgroup created telehealth competencies for the delivery of care to older adults and care partners for interprofessional learners. Competencies incorporate key telehealth, interprofessional and geriatric domains, and were informed by diverse stakeholders within the Veterans Health Administration. During this symposium, comments will be solicited from attendees. Once finalized, these competencies will drive the development of robust curricula and evaluation measures aimed at training the next generation of interprofessional providers to expertly care for older adults via telehealth.

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