Abstract 90: Nursing Education: A Critical Need in the Delivery of High Quality Stroke Care

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Virginia Daggett ◽  
Linda Williams ◽  
Nicholas Burrus ◽  
Jennifer Myers ◽  
Laura Plue ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Quality Indicators ◽  
Stroke Care ◽  
Training Needs ◽  
Release Time ◽  
Multidisciplinary Teams ◽  
Care Providers ◽  
Acute Stroke Care ◽  
High Quality ◽  
And Training

Objectives: High quality stroke care is complex, and requires strong multidisciplinary teams, including nurses, to ensure care processes are timely and appropriate. The purpose of this study was to identify training needs of nurses who deliver care to patients who present with acute stroke and are admitted to inpatient units. Methodology: Using semi-structured interviews, we conducted a qualitative study for a formative evaluation in 12 Department of Veterans Affairs Medical Centers (VAMCs) that had ≥ 50 acute ischemic stroke admissions a year and were diverse in the structure of stroke care. The interviews focused on current context and structure of stroke care, including educational practices and training needs. Secondary analyses were conducted, targeting frontline nurse and physician respondents (N = 113) in emergency, acute care and rehabilitation units. Results: Respondents across the sites reported insufficient nurse education and training for acute stroke care as an overarching theme. Moreover, themes related to the acute stroke care quality indicators emerged as areas of competencies that nurses needed training on a continuum: a) timely recognition of acute stroke and transient ischemic attacks, b) NIH Stroke Scale and neurological exams, c) dysphagia screening, d) administration of tissue plasminogen activator and management post treatment, and e) deep vein thrombosis prophylaxis. Themes that were related to structure of stroke care and/or context also emerged and attributed to training challenges across the sites, listed in order of prevalence: a) centralized care versus decentralized care, b) low volume of acute strokes, c) nurse engagement, d) structured acute stroke care education, and e) release time. Conclusions: VA stroke care providers identify educational needs around specific stroke quality indicators, but also describe key barriers including lower volume, time for training and engagement of nursing staff in acute stroke care. Future programs to improve VA stroke care need to address these barriers to optimally support high quality multidisciplinary stroke care.

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.

Ten Years of Improving Acute Stroke Management in a Metropolitan Area: A Population-Based Quantification of Quality Indicators

2021 ◽  
pp. 1-11
Author(s):  
Anna Alegiani ◽  
Michael Rosenkranz ◽  
Leonie Schmitz ◽  
Susanne Lezius ◽  
Günter Seidel ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Quality Indicators ◽  
Metropolitan Area ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Stroke Units ◽  
Stroke Treatment ◽  
Acute Stroke Treatment ◽  
Over Time

<b><i>Background and Purpose:</i></b> Rapid access to acute stroke treatment improves clinical outcomes in patients with ischemic stroke. We aimed to shorten the time to admission and to acute stroke treatment for patients with acute stroke in the Hamburg metropolitan area by collaborative multilevel measures involving all hospitals with stroke units, the Emergency Medical Services (EMS), and health-care authorities. <b><i>Methods:</i></b> In 2007, an area-wide stroke care quality project was initiated. The project included mandatory admission of all stroke patients in Hamburg exclusively to hospitals with stroke units, harmonized acute treatment algorithms among all hospitals, repeated training of the EMS staff, a multimedia educational campaign, and a mandatory stroke care quality monitoring system based on structured data assessment and quality indicators for procedural measures. We analyzed data of all patients with acute stroke who received inhospital treatment in the city of Hamburg during the evaluation period from the quality assurance database data and evaluated trends of key quality indicators over time. <b><i>Results:</i></b> From 2007 to 2016, a total of 83,395 patients with acute stroke were registered. During this period, the proportion of patients admitted within ≤3 h from symptom onset increased over time from 27.8% in 2007 to 35.2% in 2016 (<i>p</i> &#x3c; 0.001). The proportion of patients who received rapid thrombolysis (within ≤30 min after admission) increased from 7.7 to 54.1% (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Collaborative stroke care quality projects are suitable and effective to improve acute stroke care.

scholarly journals Variations in Quality Indicators of Acute Stroke Care in 6 European Countries

Stroke ◽  
2012 ◽  
Vol 43 (2) ◽  
pp. 458-463 ◽  
Author(s):  
Silke Wiedmann ◽  
Bo Norrving ◽  
Tim Nowe ◽  
Sònia Abilleira ◽  
Kjell Asplund ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Quality Indicators ◽  
Stroke Care ◽  
European Countries ◽  
Acute Stroke Care

scholarly journals Simulation training programs for acute stroke care: Objectives and standards of methodology

2020 ◽  
Vol 5 (4) ◽  
pp. 328-335
Author(s):  
Barbara Casolla ◽  
Maria Alonso de Leciñana ◽  
Raquel Neves ◽  
Waltraud Pfeilschifter ◽  
Veronica Svobodova ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Simulation Training ◽  
Time Window ◽  
Stroke Care ◽  
Education And Training ◽  
Acute Stroke Care ◽  
Simulation Techniques ◽  
Team Working ◽  
Set Up ◽  
And Training

The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.

Interaction between stroke severity and quality indicators of acute stroke care: a single-center retrospective analysis

2021 ◽  
Author(s):  
Sofie Ordies ◽  
Gwendolyne Peeters ◽  
Anouk Lesenne ◽  
Patrick Wouters ◽  
Ludovic Ernon ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Retrospective Analysis ◽  
Quality Indicators ◽  
Stroke Care ◽  
Stroke Severity ◽  
Single Center ◽  
Acute Stroke Care

Quality indicators in acute stroke care: a prospective observational survey in 13 Italian regions

2013 ◽  
Vol 26 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Antonio Di Carlo ◽  
◽  
Gabriele Accetta ◽  
Marzio Bellan ◽  
Gianna Terni ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Quality Indicators ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Italian Regions

scholarly journals Health care providers’ perceptions of factors that influence the provision of acute stroke care in urban and rural settings: A qualitative study

2020 ◽  
Vol 8 ◽  
pp. 205031212092108
Author(s):  
Mitchell Dwyer ◽  
Gregory M. Peterson ◽  
Seana Gall ◽  
Karen Francis ◽  
Karen M. Ford
Keyword(s):  
Qualitative Study ◽  
Focus Groups ◽  
Acute Stroke ◽  
Stroke Care ◽  
Rural Hospitals ◽  
Public Hospitals ◽  
Barriers And Facilitators ◽  
Care Providers ◽  
Acute Stroke Care ◽  
Data Set

Objectives: Individuals living in rural areas have comparatively less access to acute stroke care than their urban counterparts. Understanding the local barriers and facilitators to the use of current best practice for acute stroke may inform efforts to reduce this disparity. Methods: A qualitative study featuring semi-structured interviews and focus groups was conducted in the Australian state of Tasmania. Clinical staff from a range of disciplines involved in acute stroke care were recruited from three of the state’s four major public hospitals (one urban and two rural). A semi-structured interview guide based on the findings of an earlier quantitative study was used to elicit discussion about the barriers and facilitators associated with providing acute stroke care. An inductive process of thematic analysis was then used to identify themes and subthemes across the data set. Results: Two focus groups and five individual interviews were conducted. Four major themes were identified from analysis of the data: systemic issues, clinician factors, additional support and patient-related factors. Acute stroke care within the study’s urban hospital was structured and comprehensive, aided by the hospital’s acute stroke unit and specialist nursing support. In contrast, care provided in the study’s rural hospitals was somewhat less comprehensive, and often constrained by an absence of infrastructure or poor access to existing resources. Conclusion: The identified factors help to characterise acute stroke care within urban and rural hospitals and will assist quality improvement efforts in Tasmania’s hospitals.

scholarly journals Association Between Adherence to Quality Indicators and 7-Day In-Hospital Mortality After Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3664-3672
Author(s):  
Kirsten Haas ◽  
Viktoria Rücker ◽  
Peter Hermanek ◽  
Björn Misselwitz ◽  
Klaus Berger ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Stroke ◽  
Quality Indicators ◽  
Random Effect ◽  
Multivariable Analysis ◽  
Stroke Care ◽  
Evidence Based ◽  
Acute Stroke Care

Background and Purpose: Quality indicators (QI) are an accepted tool to measure performance of hospitals in routine care. We investigated the association between quality of acute stroke care defined by overall adherence to evidence-based QI and early outcome in German acute care hospitals. Methods: Patients with ischemic stroke admitted to one of the hospitals cooperating within the ADSR (German Stroke Register Study Group) were analyzed. The ADSR is a voluntary network of 9 regional stroke registers monitoring quality of acute stroke care across 736 hospitals in Germany. Quality of stroke care was defined by adherence to 11 evidence-based indicators of early processes of stroke care. The correlation between overall adherence to QI with outcome was investigated by assessing the association between 7-day in-hospital mortality with the proportion of QI fulfilled from the total number of QI the individual patient was eligible for. Generalized linear mixed model analysis was performed adjusted for the variables age, sex, National Institutes of Health Stroke Scale and living will and as random effect for the variable hospital. Results: Between 2015 and 2016, 388 012 patients with ischemic stroke were reported (median age 76 years, 52.4% male). Adherence to distinct QI ranged between 41.0% (thrombolysis in eligible patients) and 95.2% (early physiotherapy). Seven-day in-hospital mortality was 3.4%. The overall proportion of QI fulfilled was median 90% (interquartile range, 75%–100%). In multivariable analysis, a linear association between overall adherence to QI and 7-day in-hospital-mortality was observed (odds ratio adherence <50% versus 100%, 12.7 [95% CI, 11.8–13.7]; P <0.001). Conclusions: Higher quality of care measured by adherence to a set of evidence-based process QI for the early phase of stroke treatment was associated with lower in-hospital mortality.

scholarly journals Support of New Triage Protocol among Acute Stroke Care Providers

2018 ◽  
Vol 7 (5) ◽  
pp. 241-245
Author(s):  
Haitham M. Hussein ◽  
David C. Anderson
Keyword(s):  
Acute Stroke ◽  
Online Survey ◽  
Medical Service ◽  
Stroke Care ◽  
Care Providers ◽  
Large Vessel Occlusion ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Triage Protocol ◽  
Almost All

Objective: We conducted an online survey to gauge the acceptance of sending acute stroke patients with suspected large vessel occlusion (LVO) directly to an endovascular-capable hospital (ECH) even if that means bypassing a closer alteplase-capable hospital (ACH) without endovascular capability. Methods: The survey was composed of two cases of acute stroke, one with cortical symptoms suggestive of LVO and the other without. In each case, responders were asked to choose between triaging to a closer ACH or an ECH that is further away and to provide an opinion regarding the maximum extra travel time they would tolerate if they chose the ECH. The survey was sent electronically to national groups of neurologists, emergency department (ED) physicians, emergency medical service (EMS) directors, and stroke coordinators. Results: There were 320 responders from 44 states, most of them with 10 years or more of experience. Most of the responders, 72.5%, chose ECH for the LVO case, while 56% chose ACH for the non-LVO case. There were marked differences in responses by specialty: neurology strongly supported ECH for LVO and strongly supported ACH for non-LVO, most ED and EMS chose ECH for both cases, and stroke coordinators were the least supportive of bypassing ACH. Almost all groups agreed on 30 min as the acceptable extra transfer time to ECH. Conclusion: Among the survey responders, there is a broad acceptance of the idea of bypassing ACH and going straight to ECH when LVO is suspected; however, there is less agreement on triaging patients with non-LVO stroke.

Tools for your stroke team: adapting crew-resource management for acute stroke care

2018 ◽  
Vol 19 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Laurent M. Willems ◽  
Natalia Kurka ◽  
Ferdinand Bohmann ◽  
Peter Rostek ◽  
Waltraud Pfeilschifter
Keyword(s):  
Resource Management ◽  
Acute Stroke ◽  
Human Error ◽  
Improve Patient Safety ◽  
High Reliability ◽  
Management Strategies ◽  
Crew Resource Management ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
And Training

Crew-resource management is an approach to work and training that focuses on non-technical skills and strategies to prevent human error in complex procedures. It was initially termed ‘cockpit-resource management’ and developed for aviation in the 1970s after several severe accidents; it has contributed to a measurable increase in flight safety. In recent years, this approach has been successfully implemented in other high-reliability environments; surgical disciplines have made particular use of crew-resource management strategies and training, with resulting reduced mortality rates. The stepwise implementation of different crew-resource management strategies in stroke care at our tertiary stroke centre has helped to speed up process times significantly, and to improve patient safety and staff satisfaction. Here, we summarise our experience in adapting different crew-resource management tools to acute stroke care, sharing specific tools that have proven valuable in our hands, and we encourage colleagues to implement such strategies in acute stroke care.

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