Abstract TP350: Protecting Stroke Patients from Aspiration and Mortality through a Bedside Aspiration Screen

Background: Stroke patients initially experience dysphagia approximately 42-76% of the time, putting them at high risk for developing aspiration pneumonia and increasing the risk of death threefold in the first 30 days following onset of the condition. Interventions to identify risk for aspiration pneumonia are key to reducing mortality in hospitalized patients. However, no generally recognized bedside aspiration screen exists, and few have been rigorously tested. The Edith-Huhn-Matesic Bedside Aspiration Screen (EHMBAS) TM was developed as an evidence-based RN bedside aspiration screening protocol. Purpose: This study analyzed the sensitivity and inter-rater reliability of EHMBAS TM , assessed the efficacy of training methods, evaluated patient feedback, and looked at the impact of organizational learning. Methods: RNs were trained to apply the EHMBAS TM . An evaluation study assessed the sensitivity, specificity and predictability of the screen to detect aspiration in the stroke population study group. Cohen’s Kappa statistics was applied to test inter-rater reliability. Pre- and post-implementation Likert surveys examined patient and staff satisfaction on the education plan and screening process, respectively. Lastly, an analysis of organizational learning examined whether changes enhanced adherence to screening requirements. Results: Results showed that the EHMBAS TM demonstrated strong validity (94% sensitivity) and high inter-rater reliability (Kappa = .92, p<.001). Pre- and post- staff training survey results demonstrated a significant positive change in knowledge gained, feelings of preparedness, and satisfaction with teaching methods. Further, 92.3% of patients surveyed had positive screening experiences. The hospital received Silver recognition from The American Heart Association for following stroke treatment guidelines 85% of the time for at least 12 months, demonstrating the positive impact of the protocol on organizational change. Conclusions: This study contributes to the body of work aimed at establishing a reliable evidence-based, bedside aspiration screen. Patient safety is enhanced, because screen results help determine when patients can safely receive medication and nutrition by mouth.

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Developing and Testing a Bedside Aspiration Screen to Protect Stroke Patients From Aspiration and Mortality: Expanding Nursing Practice and Partnership

Clinical Scholars Review ◽

10.1891/1939-2095.8.1.117 ◽

2015 ◽

Vol 8 (1) ◽

pp. 117-124

Author(s):

Edith K. Huhn-Matesic

Keyword(s):

Acute Stroke ◽

The United States ◽

The Body ◽

Evidence Based ◽

Institute Of Medicine ◽

Stroke Patients ◽

Risk Of Death ◽

Stroke Population ◽

Screening Protocol ◽

Strategic Training

Stroke is the 4th leading cause of death in the United States at a rate of 1 death every 4 min. Stroke patients initially experience dysphagia 42%–76% of the time, putting them at high risk for developing aspiration pneumonia, increasing the risk of death three-fold in the first 30 days following onset of the condition. The Edith-Huhn-Matesic Bedside Aspiration Screen (EHMBAS) was developed as an evidence-based registered nurse (RN) bedside aspiration screening protocol. It represents an example where a strategic training program and multidisciplinary collaboration enabled nurses to broaden their education and scope of practice to improve care to the stroke population on the acute stroke unit. As recommended by the Institute of Medicine (2011) report, nurses advanced the health of stroke patients. The EHMBAS demonstrated strong validity (94% sensitivity) and high interrater reliability (Kappa = .92, p < .001). Pre- and poststaff training survey results verified a significant positive change in knowledge gained, preparedness, and satisfaction with teaching methods. Furthermore, 92.3% of patients surveyed had positive screening experiences. The multidisciplinary stroke team was highly effective at implementing stroke guidelines expeditiously, saving lives in this population. This study was significant in that it contributed to the body of work aimed at establishing a sustainable valid, and reliable evidence-based, bedside aspiration screen that can be promptly completed for acute stroke victims.

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Abstract 1122‐000242: Effect of Covid‐19 on Stroke Treatment in Australia and New Zealand

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000242 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Ela Machiroutu

Keyword(s):

New Zealand ◽

Stroke Care ◽

Small Subset ◽

Stroke Patients ◽

Secondary Research ◽

Stroke Treatment ◽

Survey Tool ◽

Early Adoption ◽

Survey Responses ◽

The Impact

Introduction : In general, compared to the rest of the world, the impact of Covid‐19 in the Australia and New Zealand regions has been minimal and this may be attributed to their early adoption of social distancing, stable governments, national wealth and geographic isolation. However, this research was designed to validate this perception amongst the stakeholders. Methods : This research included: primary and secondary research. First, secondary research about Covid‐19 and stroke treatment and Australia and New Zealand in particular was conducted and compiled in a Google spreadsheet. Research sources include Stroke Foundation, Brain Foundation, and World Meters. Data collected included the number of stroke and Covid‐19 cases in Australia and New Zealand as well as a list of stakeholders with their contact information. The stakeholders included neurosurgeons, hospitals, neurologists, interventionists, and vascular surgeons. A survey tool and an interview questions were prepared next. The survey request was emailed to stakeholders, requesting the stakeholders for an interview and survey response. Over the following weeks, survey results came in and interviews were conducted. Since only a small subset of stakeholders responded to the survey (6 survey responses and 4 interviews), this study must be considered to be primarily qualitative in nature. The interviews were conducted online using Zoom. After the interviews, I replayed the interviews and took notes of important details. Results : The survey showed that 83% of the doctors worked in a hospital that had a separate stroke unit and that they perform mechanical thrombectomies most often as a treatment for stroke. Most of the doctors suggested that the stroke numbers have not changed significantly since Covid‐19. Yet, 50% of the doctors said that there had been delays in admitting stroke patients. One third believed Covid‐19 may have made an impact on mortality of stroke patients. One of the interviewees revealed that the main barriers to access to stroke care are the time it takes to treat the patient, fewer locations that treat strokes or perform mechanical thrombectomy, and patients’ reluctance to go to the hospital during the pandemic. Another confirmed that she did think there had been delays due to Covid‐19. Conclusions : Counter to widespread perception, Covid‐19 pandemic DID worsen many barriers for stroke treatment in Australia and New Zealand. These regions have insufficient stroke centers and these are not spread out widely enough for accessibility. Stroke deaths have increased during the Covid‐19 pandemic. Barriers such as time, accessibility, and the patient’s fear of hospitals have affected stroke treatment during the pandemic. Several measures can alleviate the impact: stroke awareness is critical. Every hospital needs to have the ability to assess and treat stroke. Hospitals must run simulations to practice and prepare for different scenarios that they could encounter when dealing with stroke patients. In conclusion, stroke treatment has been affected by the Covid‐19 pandemic and it is critical to minimize and overcome these barriers as stroke is one of the leading causes of death in Australia and New Zealand.

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Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18000766 ◽

2018 ◽

Vol 33 (5) ◽

pp. 501-507 ◽

Cited By ~ 1

Author(s):

Timmy Li ◽

Jeremy T. Cushman ◽

Manish N. Shah ◽

Adam G. Kelly ◽

David Q. Rich ◽

...

Keyword(s):

Ischemic Stroke ◽

Barriers To Care ◽

Prehospital Care ◽

Heart Association ◽

Living Alone ◽

Stroke Patients ◽

Publication Type ◽

Stroke Treatment ◽

Significant Difference ◽

The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

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Abstract P293: Disparate Outcomes for Stroke Patients With Documented Substance Use Compared to Those Without Substance Use

Stroke ◽

10.1161/str.52.suppl_1.p293 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Leslie Corless ◽

Tamela L Stuchiner ◽

Cameron Garvin ◽

Alexandra C Lesko ◽

Elizabeth Baraban

Keyword(s):

Substance Use ◽

Patient Characteristics ◽

Stroke Care ◽

Stroke Patients ◽

Chi Square ◽

Stroke Treatment ◽

Discharge Disposition ◽

Healthcare Settings ◽

Medical Histories ◽

The Impact

Background: Few studies have shown the impact of substance use (SU) on treatment and outcomes of stroke patients. Research suggests stigma related to SU impacts patient experience in healthcare settings. In this study we assessed whether there were differences in patient characteristics and outcomes for stroke patients with SU compared to those with no substance use (NSU). Methods: Retrospective data from two Oregon hospitals included patients admitted with stroke diagnosis, 18 years or older, who discharged between October 2017 and May 2019. Patients with documented SU and specific SU type were compared to patients with NSU with regard to demographics, medical history, stroke subtypes, treatment, discharge disposition and length of stay (LOS). SU was defined as any documented abuse of alcohol (ETOH), methamphetamine (MA), cannabis, opiates, cocaine, benzodiazepines, and Methyl-enedioxy-methamphetamine (MDMA). Non parametric median tests and Pearson’s chi square tests were used. Results: Among 2,030 patients included in the analysis, 13.8% (n=280) were SU and 86.2% (n=1,750) were NSU. Patients with SU were significantly younger, median age (61 vs. 73, p <.001) and less were female (35.4% vs. 53.6%, p <0.001). Those with SU had lower prevalence of dyslipidemia (43.6% vs. 59.5%, p <0.001), AFIB (12.5% vs. 22.2%, p <0.001), and previous TIA (6.1% vs 10.8%, p=0.02), and more smoked (54.3% vs 13.3% p <0.001). More patients with SU arrived via transfer (38.4% vs 27.4%, p=.001). Fewer patients with SU expired or were discharged to hospice (8.9% vs 13.7%) and a greater percent left against medical advice (AMA) (3.2% vs 0.6%) (p<.001). When comparing specific SU types to NSU, all SU groups were younger, had similar medical histories and a greater proportion left AMA. Only MA users had differentiating stroke diagnoses with a higher percent of SAH (14.5% vs 5.6%) (p=.003) in addition to longer LOS (6 vs 4 days, p=.006). No differences were found in acute stroke treatment rates. Conclusion: Patients with SU were demographically different from the NSU population and did differentiate on some stroke care outcomes and processes, potentially indicating opportunities to address stigma around substance use to meet the needs of patients with both stroke and substance use.

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EVALUATION OF ELECTROMAGNETICS RADIATION FOR STROKE PATIENTS AND NON-STROKE PARTICIPANTS ACCORDING TO BODY SEGMENTATION

Jurnal Teknologi ◽

10.11113/jt.v78.8927 ◽

2016 ◽

Vol 78 (6-3) ◽

Author(s):

R.S.S.A. Kadir ◽

Zunairah Hj Murat ◽

M.N. Taib ◽

Siti Zura A. Jalil

Keyword(s):

Human Body ◽

Average Frequency ◽

Dipole Antenna ◽

The Body ◽

Stroke Patients ◽

Stroke Treatment ◽

Average Value ◽

Body Segmentation ◽

The Right ◽

Frequency Detector

This research evaluates the electromagnetic radiation (EMR) for the stroke patients and non-stroke patients according to body segmentation. The human body is divided into three segments: top, middle and bottom. The frequency in hertz is collected at 23 points around the human body namely left side, right side and chakra points from 199 subjects undergoing post-stroke treatment and 100 non-stroke participants. The EMR is captured using frequency detector equipped with a dipole antenna. The data is collected by taking the reading of the frequency 5 times at each point at the same location; hence, the average value is calculated. The statistical analysis of the EMR are examined using SPSS software and Microsoft excel is used to calculate the average frequency of the data. In conclusion, the findings significantly shows that stroke patients has lower frequency value of EMR for both right side and left side but has higher frequency for chakra system. This is true for all the three segments of the body. Furthermore, it is also shown that there is no correlation between the left and the right side frequency for the stroke patients whereas the left-right correlation values are significantly high for the non-stroke participants. This observation justify that EMR from human body can contribute to early detection for stroke.

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Comparison of conventional and modern methods in determining ischemic stroke etiology by general and stroke neurologists

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1806-29 ◽

2019 ◽

Author(s):

REFİK KUNT ◽

MUSTAFA KÜRŞAD KUTLUK ◽

BEDİLE İREM TİFTİKÇİOĞLU ◽

NAZİRE EFSER YEŞİM AFŞAR FAK ◽

ALİ KEMAL ERDEMOĞLU ◽

...

Keyword(s):

Ischemic Stroke ◽

Evidence Based ◽

Q Value ◽

Stroke Patients ◽

Stroke Treatment ◽

Subtype Assignment ◽

Stroke Etiology ◽

Medical Centers ◽

Modern Methods

Background/aim: To investigate the consistency between stroke and general neurologists in subtype assignment using Trial of ORG-10172 using Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems. Materials and methods: Fifty consecutive, acute ischemic stroke patients admitted to Stroke Unit were recruited. Patients were classified two stroke and two general neurologists, each from different medical centers, according to TOAST followed by CCS. Each neurologist was assessed for consistency and compliance in pairs. Concordance among all four neurologists was investigated and evaluated using Kappa(ĸ)-value. Results: Kappa(ĸ)-value of diagnostic compliance between stroke neurologists was 0.61 (95%CI 0.45-0.77) for TOAST and 0.78 (95%CI 0.62-0.94) for CSS-5. Kappa(ĸ)-value was 0.64 (95%CI 0.48–0.80) for TOAST and 0.75 (95%CI 0.60–0.91) for CCS-5 for general neurologists. Compliance was moderate [ĸ:0.59 (95%CI 0.52–0.65)] in TOAST and was strong [ĸ:0.75 (95%CI 0.68–0.81)] in CCS-5 for all 4 neurologists. ‘Cardioembolism’(91.04%) has reached the highest compliance in both systems. The frequency of group with ‘undetermined etiologies’ was less in CCS (26%) compared to TOAST. Conclusions: The CCS system improved the compliance in both stroke and general neurologists compared with TOAST. These suggest that automatic, evidence-based, easily reproducible CCS system was superior to TOAST system. Keywords: TOAST, CCS, Ischemic stroke, Etiology

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Endovascular treatment of ischaemic stroke patients - new evidence and old challenges

VASA ◽

10.1024/0301-1526/a000537 ◽

2016 ◽

Vol 45 (4) ◽

pp. 267-274 ◽

Cited By ~ 1

Author(s):

Johannes Gerber ◽

Volker Puetz ◽

Ulf Bodechtel ◽

Hagen Kitzler ◽

Ruediger von Kummer ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Standard Of Care ◽

Interdisciplinary Cooperation ◽

Evidence Based ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion ◽

Stroke Treatment ◽

New Evidence

Abstract. An overwhelming benefit from endovascular treatment of ischaemic stroke could be shown in recent clinical trials, making it the new evidence-based standard of care for ischaemic stroke due to large vessel occlusion. To provide all eligible stroke patients with this therapy at any time, stroke networks and hospitals should streamline their workflow to rapidly image, select, and treat stroke patients. Interdisciplinary cooperation is vital for effective emergency endovascular stroke treatment, which is one of the most complex multidisciplinary functions a hospital can undertake.

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Abstract 3379: Benefiting the Community; The Impact of Joining a Regional Stroke Network

Stroke ◽

10.1161/str.43.suppl_1.a3379 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Nancy D Papesh ◽

James Gebel

Keyword(s):

Acute Stroke ◽

Care Center ◽

Tertiary Care ◽

Cleveland Clinic ◽

Stroke Care ◽

Stroke Patients ◽

Acute Stroke Care ◽

Stroke Treatment ◽

The Impact ◽

Iv Tpa

Background: The Cleveland Clinic Health System (CCHS) consists of a large tertiary care center and 10 regional hospitals. It is organized both clinically and administratively into multispecialty organ based Institutes rather than departments. The CCHS re-introduced a regional initiative to standardize stroke care in 2008. Medina Hospital is a 118-bed community hospital in rural North-eastern Ohio, where there is a high stroke burden and previously minimal IV tPA use. Medina Hospital joined the CCHS Stroke Network in November 2009. Hypothesis: We hypothesized that after joining the formally organized stroke CCHS system of care, the proportion of stroke patients receiving IV tPA and the timeliness of administration of acute thrombolytic therapy would both significantly increase. Methods: Data was analyzed from our prospective participation in the Get with the Guidelines-Stroke and the Ohio Coverdell Stroke Registries. Baseline data regarding quality, outcomes and stroke performance measures were reviewed. CCHS initially supported acute stroke care in early 2010 with a telemedicine cart and then introduced 24/7 emergency, on-site, CCHS neurologist, acute stroke call coverage in late 2010. Standardized CCHS stroke care pathways and order sets were also introduced in 2010. The proportion of stroke patients treated with IV tPA in 2010 and 2011 (post- joining CCHS) was compared to 2009 (2-sided Fisher’s exact test), and door-to-needle times were compared from 2010 to 2011 (unpaired t-test). Results: IV tPA treatment utilization increased from 0/69 patients (0%) in 2009 to 9/67 patients (11.8%) in 2010 [exact p=.0033] and 11/46 (19.3%) in the first 7 months of 2011 [exact p=.0001]. Door-to-needle times improved from a mean of 81.4 (95%CI 66.4 to 96.4) minutes in 2010 to 61.7 (95% CI 52.7 to 70.8) minutes in 2011 (p=.0158). Conclusions: Participation in an organized formal collaborative regional hospital stroke treatment network resulted in dramatic improvements from zero IV tPA utilization to greatly exceeding the national benchmark averages for both percentage treatment with IV tPA and door-to-needle time in a rural area where patients previously had minimal access to acute stroke expertise.

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Stroke: the critically neglected first year post-stroke

Journal of Integrated Care ◽

10.1108/jica-09-2017-0030 ◽

2018 ◽

Vol 26 (1) ◽

pp. 4-15

Author(s):

Kenneth Gaines ◽

Patricia Commiskey

Keyword(s):

Integrated Care ◽

Care Delivery ◽

Care Facility ◽

Stroke Care ◽

Evidence Based ◽

Care Model ◽

Stroke Patients ◽

Post Discharge ◽

Content Type ◽

The Impact

Purpose Stroke is a leading cause of death and disability in the USA and worldwide. While stroke care has evolved dramatically, many new acute approaches to therapy focus only on the first 3-12 hours. Significant treatment opportunities beyond the first 12 hours can play a major role in improving outcomes for stroke patients. The purpose of this paper is to highlight the issues that affect stroke care delivery for patients and caregivers and describe an integrated care model that can improve care across the continuum. Design/methodology/approach This paper details evidence-based research that documents current stroke care and efforts to improve care delivery. Further, an innovative integrated care model is described, and its novel application to stroke care is highlighted. Findings Stroke patients and caregivers face fragmented and poorly coordinated care systems as they move through specific stroke nodes of care, from acute emergency and in-hospital stay through recovery post-discharge at a care facility or at home, and can be addressed by applying a comprehensive, technology-enabled Integrated Stroke Practice Unit (ISPU) Model of Care. Originality/value This paper documents specific issues that impact stroke care and the utilization of integrated care delivery models to address them. Evidence-based research results document difficulties of current care delivery methods for stroke and the impact of that care delivery on patients and caregivers across each node of care. It offers an innovative ISPU model and highlights specific tenets of that model for readers.

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