Abstract W P296: Establishing a Stroke Protocol Based on the Trauma Model

Background and Purpose: In the summer of 2012, the state of Pennsylvania adopted legislation mandating EMS providers to deliver all patients with clinical signs of stroke to a certified stroke center for evaluation. In response to this change, development of a new stroke program began at a tertiary medical center located in the northeastern region of the state. The facility was a certified trauma center and also held various other disease specific certifications through the Joint Commission. This project sought to examine the needs of a newly developing primary stroke center within the context of a healthcare organization with numerous other specialized medical and surgical programs. Specifically, the investigators hoped to illustrate the similarities between stroke and other specialized services to demonstrate that many of the requirements of these programs are shared. Method: The site stroke clinical coordinator and system stroke program coordinator kept detailed records of all phases of stroke program development. As resource needs were identified, notation was made indicating whether or not those resources were already available in the hospital. By examining these records, the coordinators were able to identify how many of the resources needed to develop an effective stroke program were already present within the system. Results: Information was collected beginning at the inception of program development in 2012 through the time of application for Joint Commission Primary Stroke Center certification in August of 2013. During these 9 months, many of the needed resources were found to already exist in the facility, with most having been created or added as a result of the hospital’s trauma program development several years earlier. Conclusion: The hospital was able to develop a high performing stroke center with comparative ease due to the preexisting resources from the institution’s trauma program. It is the belief of the stroke team that these results could be easily duplicated in other facilities with trauma services that wish to expand into stroke specialization as well.

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Abstract WP363: Journey of a Five-Hospital System to Primary Stroke Center Certification

Stroke ◽

10.1161/str.44.suppl_1.awp363 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Deb Motz ◽

Dicky Huey ◽

Tracy Moore ◽

Byron Freemyer ◽

Tommye Austin

Keyword(s):

Administrative Support ◽

Medical Center ◽

Academic Medical Center ◽

Stroke Care ◽

Multidisciplinary Teams ◽

Hospital System ◽

Order Sets ◽

Primary Stroke Center ◽

Stroke Center ◽

Evidenced Based

Background: In 2008, a city with a population of over one million people had no organized stroke care or Certified Primary Stroke Centers. Patients presenting with stroke symptoms had inconsistent neurology coverage and little or no access to rtPA. The purpose is to describe steps taken for five acute-care hospitals (with one CMS provider number) to become Primary Stroke Certified. Methods: The journey began with administrative support and a commitment to provide the resources for a successful program. To oversee development, a Medical Director and Stroke Coordinator were appointed. To bridge the gap in available specialty physicians, partnerships were formed with a telemedicine group to provide emergency treatment and an academic medical center to augment the neurology and neuro-surgical coverage. Multidisciplinary teams met monthly in each facility. Representatives from each team formed a regional committee and an education council was created to share best practices and assure consistency across the system. Evidenced based order sets were developed using clinical practice guidelines. The Medical Executive Committee at each facility and ultimately the Medical Executive Board endorsed the order sets and mandated their use. Each facility chose the appropriate unit to cohort the stroke patients which encouraged expertise in care. Results: This journey resulted in a high functioning system of care. Baptist Health System became Joint Commission Certified in all five locations (May 2009). We were awarded the Get with the Guidelines Bronze Award (September 2010), the Silver Plus Award (July 2011) and the Gold Plus Award (July 2012). In addition, we were the first in Texas to achieve the Target Stroke Honor Roll (Q3 2011) and have maintained this status for eight consecutive quarters. Conclusion: In conclusion, administrative support is imperative to the success of a stroke program. Leadership, partnerships, committees, councils and staff involvement from the start drove the team to a successful certification process with outstanding outcomes. The stroke committees continue to meet monthly to analyze performance measures, identify opportunities for improvement and execute action plans.

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Abstract WP455: Memorial Hermann Hospital System Stroke Coordinators: Working as One

Stroke ◽

10.1161/str.51.suppl_1.wp455 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sandi G Shaw ◽

Isabel Gonzales ◽

Hari Indupuru ◽

Nicole Harrison ◽

Sean Savitz ◽

...

Keyword(s):

Best Practice ◽

Quality Care ◽

High Volume ◽

Work Load ◽

Joint Commission ◽

Large Hospital ◽

Hospital System ◽

Primary Stroke Center ◽

Stroke Center ◽

The Joint Commission

Background: Many hospital stroke programs fail to meet or maintain the certification requirements of The Joint Commission (TJC) as a Primary Stroke Center (PSC) or Comprehensive Stroke Center (CSC). The most common reason is the absence of a dedicated stroke program coordinator. There are opportunities for improvement to promote stroke coordinator growth and retention. Purpose: We created The Memorial Hermann Hospital System Stroke Coordinator Alliance to combine resources, reduce workload, and support stroke coordinators in order to promote adherence to best practice and maintain TJC stroke certification. Methods: The Memorial Hermann Hospital System Stroke Coordinator Alliance was developed in 2015. It includes 14 nurses who represent 11 acute care hospitals within a large hospital system in Houston (Figure1). Four of the hospitals are CSCs, five are PSCs, and two are not certified. Monthly meetings are conducted to create standardized access to resources, stroke coordinator orientation, education, medical power plans, process improvement, and data development. Coordinator work groups, a central email and shared drive, biweekly data meetings, and a buddy system were created to reduce work load, improve electronic communication, and streamline data review procedures. A partnership was created to onboard new coordinators and to prepare for mock and real time survey visits. In 2018 data abstraction was standardized across hospitals with use of a homegrown database Stroke Program Registry (REGIS). Results: Of the 14 Stroke Coordinators in place during fiscal years 2015 - 2019, retention was 100%. A total of 19 stroke surveys were completed and recognized as successful by The Joint Commission. A total of 17,148 stroke patients were received with PSC measures averaging greater than 95% and CSC measures above 90%. Conclusion: Implementing program development support for stroke coordinators improves retention and quality care in a high volume stroke system.

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Abstract 2623: Racial Disparities in Hospital Length of Stay among Native Hawaiians and other Pacific Islanders with Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a2623 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Kazuma Nakagawa ◽

Matthew Koenig ◽

Todd Seto ◽

Susan Asai ◽

Cherylee Chang

Keyword(s):

Ischemic Stroke ◽

Length Of Stay ◽

Medical Center ◽

Parameter Estimate ◽

Hospital Length ◽

Pacific Islanders ◽

Native Hawaiians ◽

Hospital Length Of Stay ◽

Primary Stroke Center ◽

Stroke Center

Introduction: Native Hawaiians and other Pacific Islanders (NHPI) with ischemic stroke are younger and have more comorbidities compared to other major racial-ethnic groups. However, their impact on hospital length of stay (LOS) after ischemic stroke has not been studied. Hypothesis: We assessed the hypothesis that NHPI race is associated with a longer hospital LOS after ischemic stroke. Methods: Data from 2004 to 2010 were retrospectively obtained from the Get With the Guidelines-Stroke (GWTG-Stroke) database from The Queen’s Medical Center, the only primary stroke center for the state of Hawaii. Multivariable analyses were performed using a stepwise linear regression model to identify factors predictive of hospital LOS after ischemic stroke. Results: A total of 1921 patients hospitalized for ischemic stroke (NHPI 20%, Asians 53%, whites 24%, blacks 0.8%, others 2%) were studied. Univariate analyses showed that NHPI were younger (mean ages, NHPI 60±14 vs. Asians 72±14, p <0.0001; vs. whites 71±14, p <0.0001) and had higher prevalence of diabetes (NHPI 53% vs. Asians 67%, p <0.0001; vs. whites 22%, p <0.0001), hypertension (NHPI 82% vs. whites 22%, p <0.0001), prior stroke or TIA (NHPI 30% vs. Asians 23%, p =0.01), smoking (NHPI 19% vs. Asians 14%, p =0.01), dyslipidemia (NHPI 43% vs. whites 34%, p <0.01), and longer hospital LOS (NHPI 11±17 days vs. Asians 7±9 days, p <0.0001; whites 8±17 days, p <0.05). After adjusting for age, race, gender, and risk factors with predefined significance ( p <0.1), independent predictors for hospital LOS were NHPI race (parameter estimate, 2.67; 95% CI, 1.09 - 4.22, p =0.001), atrial fibrillation/atrial flutter (parameter estimate, 2.22; 95% CI, 0.53 - 3.90, p =0.01), and age (parameter estimate, -0.04; 95% CI, -0.09 - -0.002, p =0.04). Conclusions: Native Hawaiians and other Pacific Islanders with ischemic stroke have a longer hospital length of stay compared to Asians and whites. Further studies are needed to assess if other socioeconomic factors contribute to the observed differences.

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30-Day Mortality and Readmission After Hemorrhagic Stroke Among Medicare Beneficiaries in Joint Commission Primary Stroke Center-Certified and Noncertified Hospitals

Stroke ◽

10.1161/strokeaha.111.622613 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3387-3391 ◽

Cited By ~ 63

Author(s):

Judith H. Lichtman ◽

Sara B. Jones ◽

Erica C. Leifheit-Limson ◽

Yun Wang ◽

Larry B. Goldstein

Keyword(s):

Hemorrhagic Stroke ◽

Joint Commission ◽

Medicare Beneficiaries ◽

Primary Stroke Center ◽

Stroke Center

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Abstract 3442: A Regional Assessment of Mismatch between Joint Commission Certified Stroke Centers and Population Requirements

Stroke ◽

10.1161/str.43.suppl_1.a3442 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Bo Connelly ◽

Will Meland ◽

Saqib A Chaudry ◽

Jacob Reshetar ◽

Adnan I Qureshi

Keyword(s):

Total Population ◽

Population Based ◽

Joint Commission ◽

Certification Program ◽

Census Block ◽

Upper Midwest ◽

High Performing ◽

Multiple Stroke ◽

Stroke Center ◽

Great Circle Distance

Background: The Joint Commission identifies high performing stroke centers through their certification program. Since the certification program does not incorporate a population based needs assessment, we hypothesized that some population centers may not contain certified centers. Furthermore, we hypothesized that inter-competitive behaviors of centers may be lead to clustering of certified centers. Methods: We identified all the primary stroke centers (PSCs) that were certified by Joint Commission through a directory maintained by the organization. We identified the addresses of all the certified stroke centers in the upper Midwest (ND, SD, MN, IA, WI) and determined the latitude and longitude coordinates for these locations. We then obtained a list of all the census blocks in the upper Midwest that included the populations and latitude and longitude coordinates for each census block. We used the Haversine formula to calculate the great circle distance between each stroke center and each census block and then identified the five stroke centers closest to each census block. From this we were able to identify the census blocks within 15 miles of multiple stroke centers in the upper Midwest. We also identified every census block within 15 miles of each stroke center. From this we calculated the total population within 15 miles of each stroke center. Results: We identified a total of 56 PSC hospitals that are serving a population of 15.4 million in 2010 in upper Midwest. Of the population served, 53% of the population lives within 15 miles of a PSC. Of these, 3%, 6%, and 1% live within 15 miles of 2,3, and 4 PSCs; 21% live within 15 miles of 5 or more PSCs. Seven PSCs have a population of ≤100,000 per PSC within 15 miles, and 49 PSCs have a population of >100,000 per PSC within 15 miles; 18 PSCs have a population of 1 million or greater within 15 miles. Conclusions: We found that almost half of the population in the Midwest does not reside within 15 miles of a PSC while one-fifth of the population resides within 15 miles of 5 or more PSCs. Such mismatches highlight the need for PSC designation to consider population needs to ensure homogeneity of care.

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Joint Commission Primary Stroke Center Certification Increases rt-PA Treatment (PD2.004)

Neurology ◽

10.1212/wnl.78.1_meetingabstracts.pd2.004 ◽

2012 ◽

Vol 78 (Meeting Abstracts 1) ◽

pp. PD2.004-PD2.004

Author(s):

M. Mullen ◽

S. Kasner ◽

M. Kallan ◽

D. Kleindorfer ◽

K. Albright ◽

...

Keyword(s):

Joint Commission ◽

Primary Stroke Center ◽

Stroke Center

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Abstract TP386: From Zero to Stroke Elite Gold Plus in Three Years

Stroke ◽

10.1161/str.48.suppl_1.tp386 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Margaret C Kester ◽

Maureen Monczewski ◽

Angela Groody ◽

Christopher Cummings ◽

Neil Holland ◽

...

Keyword(s):

Medical Center ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Joint Commission ◽

Graduate Degree ◽

Team Members ◽

Data Analyst ◽

Nurse Navigator ◽

Elite Status ◽

Stroke Center

Background and Purposes: Geisinger Community Medical Center is located in Scranton, Pennsylvania. We serve six counties with a population of 700,000. Due to the Scranton aging population, the incidence of stroke is 1.3 x the national average. We began our stroke program in March 2011 and grew to one of the best stroke programs in this region. Here, we describe our strategies leading to our success. Subjects and Methods: To achieve our goal ,beside employing routine strategies such as ongoing hospital-wide education and monthly stroke meetings; we took the following intuitive steps: 1. Recruited a stroke program coordinator who was a RN with a post-graduate degree, certified in neurological nursing and rehab counseling with substantial experience in working in a trauma unit 2. Consistent presence of the stroke coordinator in the ER and an office on the stroke floor. 3. Developed a collegial relationship with all team members 4. Bottom-up approach to gain the trust and support of nursing staff and administration 5. Consistent real-time chart review of neurology / neurosurgery consults and scanning the emergency department patients’ list . 6. Develop an organized Feedback / Performance Improvement in stroke care. 7. Weekly Rehabilitation Collaboration Meeting. 8. Kept the ER medical service highly engaged in our stroke program by having regular meetings and offering on-site education and feedback 9. Recruited a Nurse Navigator and a Data Analyst. Results: Geisinger Community Medical Center became a Joint Commission designated Primary Stroke Center and obtained a Gold Plus status in 2013. Since then, the number of treated stroke patients has increased to greater than 550. We have met the American Heart and Stroke Association and Joint Commission criteria for over 90% (95%CI: 87.5-92.5) compliance for eight stroke core measures. Our intravenous thrombolysis rate significantly increased to 12.6% (95%CI: 9.8-15.4). We achieved Honor- Roll Elite award for decreasing Door to Needle time below 60 minutes in 2015. Conclusions: Our experience indicates a few simple strategies, can make a big difference in stroke care in community hospitals. A fledgling stroke center can rise from Zero to Gold Plus with Elite Status with careful planning, coordination and caring.

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Abstract T P298: A Comparison of Stroke Time Targets for In-Hospital Versus Emergency Department Ischemic Stroke Patients at a Primary Stroke Center

Stroke ◽

10.1161/str.45.suppl_1.tp298 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Deborah R Lee-Ekblad ◽

Nan Meyers ◽

Kelly Becker ◽

Milind Chinoy ◽

Brandon Lawrence ◽

...

Keyword(s):

Emergency Department ◽

Medical Center ◽

Hospitalized Patients ◽

Stroke Patients ◽

Improvement Project ◽

Early Management ◽

Stroke Treatment ◽

Primary Stroke Center ◽

Stroke Center ◽

Ischemic Attack

Introduction: Based on the 2013 Guidelines for Early Management of Patients With Acute Ischemic Attack, hospitals and emergency departments (ED) should develop efficient processes and protocols to manage stroke patients. The guidelines have several time targets for early stroke evaluation and treatment such as door to physician, door to CT initiation, door to CT interpretation, and door to drug. The goal of these time targets is to reduce morbidity and mortality associated with stroke. Hypothesis: We hypothesize that inpatient stroke evaluation and treatment is equivalent to patients presenting to the emergency department (ED) with stroke symptoms since the same stroke team responds to both inpatient stroke call downs and ED stroke call downs. This is to obtain initial data for a quality improvement project at Borgess Medical Center, Kalamazoo, MI. Methods: Between September 2010 and June 2013, all in-hospital stroke call down charts were retrospectively reviewed. For each month that there was an inpatient stroke call down, ED stroke call downs were retrospectively chart reviewed as well. There were 24 inpatient stroke call downs and 93 ER stroke call downs during this time period. Each chart was reviewed for time targets: door to physician, door to CT initiation, door to CT interpretation, and door to drug. Results: The hospitalized stroke patients experienced more delays in care than ED stroke patients. The inpatient target times are below recommended time targets. The average time to physician for inpatient stroke patients was 5 minutes as compared to the ED was 4.2 minutes. Time to CT initiation was 31.45 minutes for hospitalized patients as compared to 25.48 minutes for ED patients. CT interpretation was 52.83 minutes for inpatient strokes as compared to 47.21 minutes for ED stroke patients. Time to tPA was 122 minutes for hospitalized patients as compared to 94 minutes for ED stroke patients. Conclusion: Hospitalized patients developing stroke symptoms have delays in care as compared to patients that present to the emergency department with stroke symptoms. This may be due to emergency department patients getting preferential treatment for tests. Identifying these delays in care is important to improve stroke treatment for hospitalized patients.

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