Abstract W P334: VA Healthcare System Responses to National Stroke Care Reorganization

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Teresa M Damush ◽  
Kristine K Miller ◽  
Laurie Plue ◽  
Arlene A Schmid ◽  
Laura Myers ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Nurse Managers ◽  
Stroke Care ◽  
Structured Interviews ◽  
Acute Stroke Care ◽  
Major Barrier ◽  
Ongoing Work ◽  
Final Sample ◽  
Cross Training ◽  
Stroke Center

Aims: In 2011, the VA released the Acute Ischemic Stroke (AIS) Directive which mandated reorganization of acute stroke care, including self-designation as Primary (P), Limited Hours (LH), or Supporting (S) stroke center. We conducted interviews across stroke centers to understand barriers and facilitators faced in response. Methods: The final sample included 38 (84% invited) facilities: 9 P, 24 LH, and 5 S facilities. In total, 107 persons were interviewed including ED Chiefs, Chiefs of Neurology, ED Nurse Managers/Nurses and other staff. Semi-structured interviews were based on the AIS Directive. Completed interviews were transcribed and analyzed using Nvivo 10. Results: Barriers reported were a lack of personnel assigned to coordinate the facility response to the directive. Data collection and lack of staff were likewise commonly reported as barriers. For thrombolysis measures, the low number of eligible Veterans was another major barrier. LH and S facilities reported some unique barriers: access to radiology and neurology services; EMS diverting stroke patients to nearby stroke centers, maintaining staff competency, and a lack of stroke clinical champions. Some solutions applied included cross training X-ray technicians to provide head CT coverage, developing stroke order sets and templates, and staff training. Larger facilities added a stroke code pager system and improved upon its use, and established ED nurses to become first alerts for an acute stroke patient. LH and S facilities also responded by attempting to secure additional services and by establishing formal transfer agreements to improve Veteran tPA access. Conclusions: The AIS Directive brought focused attention to reorganizing and improving stroke care across a range of facility types. Larger VA facilities tended to follow established practices for organizing stroke care, but the unique LH designation presented challenges to consistently organize systems. Since Veterans have financial interest in presenting to a VA facility, ongoing work to organize VA care and to improve access to thrombolysis at smaller VA facilities is needed. This protocol was supported by Genentech Inc. Protocol ML 28238, VA HSRD QUERI Rapid Response Project 11-374, and the VA Stroke QUERI Center.

Abstract P855: Importance of Compliance in Dysphagia Screening in Acute Stroke Care

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Patty Noah ◽  
Melanie Henderson ◽  
Rebekah Heintz ◽  
Russell Cerejo ◽  
Christopher T Hackett ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Aspiration Pneumonia ◽  
Hemorrhagic Stroke ◽  
Oral Intake ◽  
Stroke Care ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Chi Square ◽  
Stroke Center

Introduction: Dysphagia occurs in up to two thirds of stroke patients and can lead to serious complications such as aspiration pneumonia, which is also linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia assessment before oral intake in stroke patients regardless of initial stroke severity. Several studies have described registered nurses’ competency in terms of knowledge and skills regarding dysphagia screening. We aimed to examine the rate of aspiration pneumonia compared to the rate of dysphagia screening. Methods: A retrospective analysis of prospectively collected data at a single tertiary stroke center was carried out between January 2017 and June 2020. Data comparison was completed utilizing ICD-10 diagnosis codes to identify aspiration pneumonia in ischemic and hemorrhagic stroke patients. The data was reviewed to compare the compliance of a completed dysphagia screen prior to any oral intake to rate of aspiration pneumonia. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of aspiration pneumonia diagnosis in the ischemic and hemorrhagic stroke patients. Results: We identified 3320 patient that met inclusion criteria. 67% were ischemic strokes, 22% were intracerebral hemorrhages and 11% were subarachnoid hemorrhages. Compliance with dysphagia screening decreased from 94.2% (n=1555/1650) in 2017-2018 to 74.0% (n=1236/1670) in 2019-2020, OR=0.17 (95%CI 0.14 - 0.22), p < 0.0001. Aspiration pneumonias increased from 58 (3.5%) in 2017-2018 to 77 (4.6%) in 2019-2020, but this difference was not statistically significant, OR=0.75 (95%CI 0.53 - 1.07), p = 0.11. Conclusion: We noted that the decrease in compliance with completing a dysphagia screen in patients with acute stroke prior to any oral intake was associated with a higher trend of aspiration pneumonia.

JCAHO Stroke Center Certification as a Strategy for a Statewide System of Acute Stroke Care in North Carolina

2007 ◽  
Vol 14 (5 Supplement 1) ◽  
pp. S31-S32
Author(s):  
A. Asimos ◽  
S. Huston ◽  
L. Mettam ◽  
D. Enright
Keyword(s):  
North Carolina ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Stroke Center

Abstract WP248: Methods to Achieving a 9-minute Door to TPA Time

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Deepak S Nair ◽  
Arun Talkad ◽  
Clayton McNeil ◽  
Jan Jahnel ◽  
Teresa Swanson-Devlin ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Time Of Day ◽  
National Average ◽  
Acute Stroke Care ◽  
Stroke Treatment ◽  
The Past ◽  
Stroke Center

Introduction Despite guidelines recommending “door to needle times” (DTN) of ≤60 minutes and the Target: Stroke program, the national average for stroke treatment is 79 minutes. We present the factors that have reduced DTN in our Stroke Center. Methods We retrospectively identified all patients who received IV rt-PA using our acute stroke code database, from 2007 to 2012. The patients were organized by their DTN into four groups: <20min, 20-39min, 40-59min, and ≥60min. Median NIHSS scores were calculated, along with median DTN per group and annually. We also specified median lab times, the source of the stroke code (EMS or ED), and time of day for the code. Results There were 180 patients that received IV rt-PA: 7 patients in <20min, 49 in 20-39min, 52 in 40-59min, and 72 in ≥60min. Median DTN was 14min, 30min, 46.5min, and 76min, respectively, with the overall fastest DTN being 9 minutes. Median NIHSS scores were 7, 12, 13, and 8, respectively. EMS initiated the code in 100% of the <20min cases, 45% in 20-39min, 44% in 40-59min, and 40% in ≥60min. Eighty-six percent of the <20min cases arrived during the day, as did 84% of the 20-39min, 65% of the 40-59min, and 42% of the ≥60min cases. When rt-PA was given before labs were resulted, the median DTN was 30min; otherwise, the median DTN was 54min. All cases with <20min DTN presented after May 2011, when the first such case occurred. The median DTN was 65.5min in 2007, 51min in 2008, 61min in 2009, 59.5min in 2010, 47min in 2011, and 35min in 2012. Conclusions Our experience suggests that the “Target: Stroke” strategies (EMS initiation of stroke codes, rapid triage, rt-PA before labs) can significantly reduce the time to thrombolysis. However, our significant improvement over the past two years followed a singular 13-minute DTN, which demonstrated that teamwork and passion for acute stroke care can catalyze the consistent delivery of efficient stroke treatment.

Abstract TP244: A Successful Statewide Initiative to Designate Hospital as Remote Treatment Stroke Centers

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shelley Nichols ◽  
Debbie Camp ◽  
McCord Smith ◽  
Chris Threlkeld ◽  
James Lugtu ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Systems Of Care ◽  
Standard Of Care ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Stroke Registry ◽  
Remote Treatment ◽  
Stroke Systems Of Care ◽  
Stroke Center ◽  
Iv Tpa

Background: As treatment of acute ischemic stroke (AIS) with IV tPA has become standard of care, smaller hospitals with limited resources have struggled to conform to consensus guidelines. To fill this practice gap, stroke systems of care were developed to support smaller, often rural, hospitals in providing standard stroke care to the patients they serve. Methods: As a result of legislative support from the Coverdell-Murphy Act, the Georgia Coverdell Acute Stroke Registry (GCASR) in collaboration with the Georgia Office of EMS (GA OEMS), the Georgia Hospital Association (GHA), and other state partners, developed a method for designating hospitals as Remote Treatment Stroke Centers (RTSC). The primary focus of performance improvement was treatment with IV tPA in eligible patients. Data collection and process change were used to improve the following quality indicators: percentage of eligible AIS patients treated with IV tPA and number of stroke alert notifications. Hospitals were required to partner with an accredited stroke center and use telemedicine to support the decision for administering IV tPA. GA OEMS was charged with reviewing and surveying individual hospitals applying for RTSC status. The GCASR served as the central repository to facilitate data sharing and benchmarking across hospitals. An inter-hospital transfer tool was created for EMS providers, adopted by GA OEMS, and disseminated throughout the state to guide management of patients receiving IV tPA who required transfer from a RTSC to an accredited stroke center. Results: Starting in 2014, pertinent information was distributed and assistance provided to the 24 RTSC eligible GCASR hospitals. At present, 4 hospitals have achieved designation; 1 hospital is pending survey; and several are considering application. In 2012-13 the now 4 RTSC hospitals gave IV tPA to 8 patients. In 2014-15 as these hospitals sought and achieved designation, this number rose to 24. During this same period, stroke alerts increased from 76 to 308. Conclusion: A state-based public health stroke initiative is effective in facilitating the designation of RTSC and thereby improving the delivery of acute stroke care in underserved areas.

Abstract P871: Community and Academic Partner Creation of a Community-Informed, Behavior Theory-Based Music Video to Encourage Stroke Preparedness During the Covid-19 Pandemic

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Maria Cielito Robles ◽  
Casey Corches ◽  
Morgan Bradford ◽  
Tia Rice ◽  
Devraj Sukul ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Stroke ◽  
Stroke Care ◽  
Music Video ◽  
Community Partner ◽  
Structured Interviews ◽  
Community Members ◽  
Acute Stroke Care ◽  
Community Partners ◽  
Academic Partner

Background: Black Americans comprise 14% of Michigan’s population, but 30% of the COVID-19 cases and 40% of deaths. The accumulating national quantitative data on decreased presentation and increased pre-hospital delay during the pandemic confirmed our Flint, MI community partners’ impression of a decline in stroke presentations. Thus, we set out to understand the community’s perception of seeking acute stroke care during the pandemic which will inform the development and dissemination of public health messaging in a predominantly Black American community. Method: To honor social distancing orders, we conducted semi-structured interviews based on the Theory of Planned Behavior via HIPAA-approved teleconferencing with community members. Due to the clinical and public health implications of the pandemic, we employed a rapid assessment approach to streamline qualitative data analysis. Results were used to inform the creation of a music video. Lyrics were written by the academic team, set to a soundtrack and sung by a community partner. The music video theme was conceptualized by the academic team and performed by both academic and community partners. Results: We reached thematic saturation after completing 15 semi-structured interviews with Flint, MI community members. Mean duration of interviews was 40 minutes. Eighty percent of participants were Black; median age was 50; 74% were women and 47% reported some college or above. There was an unfavorable attitude towards seeking emergent stroke care via ambulance and at the hospital, due to concerns for viral transmission at the hospital, hospital capacity and ability to triage, and quality of care. Community and academic partners co-created a music video with verses addressing the community-identified barriers: “ stroke is an emergency all the time, even with COVID-19 / get to the hospital as soon as symptoms start, it’s so important to do your part, be Stroke Ready” (https://youtu.be/lKefAiUM2W0) The video reached over 1,200 users on our community-academic partner Stroke Ready Facebook page. Conclusion: We found that community members’ attitudes and perceived behavioral control to seek emergent stroke care were impacted during the COVID-19 pandemic. We addressed these barriers in an academic-community partner created music video. Academic and community partnerships facilitated a timely, innovative response to seeking acute stroke care in the setting of the COVID-19 pandemic.

The impact of tele-neurologists on acute stroke care at an advanced primary stroke centre

2020 ◽  
pp. 1357633X2092103
Author(s):  
Scott Gutovitz ◽  
Jonathan Leggett ◽  
Leslie Hart ◽  
Samuel M Leaman ◽  
Heather James ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Care Guidelines ◽  
Stroke Center ◽  
The Impact ◽  
Stroke Centre

Introduction We evaluated the impact of tele-neurologists on the time to initiating acute stroke care versus traditional bedside neurologists at an advanced stroke center. Methods This observational study evaluated time to treatment for acute stroke patients at a single hospital, certified as an advanced primary stroke centre, with thrombectomy capabilities. Consecutive stroke alert patients between 1 March, 2016 and 31 March, 2018 were divided into two groups based on their neurology consultation service (bedside neurology: 1 March, 2016–28 February, 2017; tele-neurology: 1 April, 2017–31 March, 2018). Door-to-tPA time and door-to-IR time for mechanical thrombectomy were compared between the two groups. Results Nine hundred and fifty-nine stroke patients met the inclusion criteria (436 bedside neurology, 523 tele-neurology patients). There were no significant differences in sex, age, or stroke final diagnosis between groups ( p > 0.05). 85 bedside neurology patients received tPA and 35 had mechanical thrombectomy, 84 and 44 for the tele-neurology group respectively. Door-to-tPA time (median (IQR)) was significantly higher among tele-neurology (64 min (51.5–83.5)) than bedside neurology patients (45 min (34–69); p < 0.0001). There was no difference in door-to-IR times (mean ± SD) between bedside neurology (87.2 ± 33.3 min) and tele-neurology (90.4 ± 33.4 min; p = 0.67). Discussion At this facility, our tele-neurology services vendor was associated with a statistically significant delay in tPA administration compared with bedside neurologists. There was no difference in door-to-IR times. Delays in tPA administration make it harder to meet acute stroke care guidelines and could worsen patient outcomes.

scholarly journals Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic

2020 ◽  
Vol 29 (9) ◽  
pp. 105068 ◽  
Author(s):  
Shashank Agarwal ◽  
Erica Scher ◽  
Nirmala Rossan-Raghunath ◽  
Dilshad Marolia ◽  
Mariya Butnar ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Acute Stroke ◽  
York City ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Abstract WMP63: Outcomes After Regionalization of Acute Stroke Care: Time Trend Analysis From Multiple Counties in the State of California

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Prasanthi Govindarajan ◽  
Steve Shiboski ◽  
Barbara Grimes ◽  
Larry Cook ◽  
David Ghilarducci ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Health Planning ◽  
Patient Discharge ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Before And After ◽  
Independent Association ◽  
Stroke Center ◽  
Status Data ◽  
Phase Iv

Objective: To determine if regionalization of acute stroke care is associated with IV t-PA use over a five year period. Methods: This is a before-after observational study of all ambulance transported patients with a discharge diagnosis of acute ischemic stroke (AIS). We excluded inter-facility transports and direct admissions. Our data sources were the patient discharge abstract file from the Office of Statewide Health Planning and Development and prehospital records. Probabilistic matching was used to link the records. Relative risk regression was performed to study the independent association of regionalization with IV t-PA use after controlling for patient, hospital demographics and stroke center status. Data analysis was performed using SAS 9.2 Results: Number of ambulance transported AIS patients to 13 hospitals in both counties were 4282 in the “before-phase” and 15571 in the “after-phase” (County 1 “after-phase” n=11368 (73%), County 2 “after-phase” n= 4203 (27%). In the “after-phase”, 10189 (65.4%) were transported to primary stroke centers and 14981 (96.2%) were treated at community hospitals. In the “before-phase” IV t-PA was given to 79 patients (1.9%) and in the “after-phase” IV t-PA was given to 514 patients (3.3%). In the model, regionalization was independently associated with higher use of IV t-PA (Overall RR: 2.4 95% CI 1.4, 4.1) aRR for County 1 - 1.2 95% CI 0.82, 1.65 aRR for County 2 - 2.4 95% CI 1.4, 4.1 Conclusions: Regionalization was associated with higher rates of thrombolysis in AIS patients. Figure 1: IV t-PA rates before and after regionalization (County 1/County 2) Table 1: Independent association of regionalization with IV t-PA use

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