Abstract T P216: A Program for Sustaining Improvements in Acute Stroke Treatment

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Abdeljalil Bentaleb ◽  
Larisa Golding ◽  
Robin Jackson ◽  
Natasha Desmond ◽  
Lewis B Eberly
Keyword(s):  
Acute Stroke ◽  
Treatment Outcomes ◽  
Outcome Measures ◽  
Medical Staff ◽  
Value Stream Mapping ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Golden Hour ◽  
Value Stream ◽  
Number Of Patients

Introduction: Efficacy of thrombolytic therapy in acute stroke patients improves when time to treatment is reduced. Previously we demonstrated improved treatment outcomes after utilizing value stream mapping to improve the efficacy of processing acute stroke patients in the emergency department (ED). We then developed programs to provide sustainability of this process. Hypothesis: Attention to process in ED management of acute stroke patients through communication, feedback and multidisciplinary stroke meetings should promote sustainability of the process and improve outcome measures. Methods: After formally implementing value stream mapping technology we took steps to maintain improved processing of acute stroke patients and improved outcomes. We developed mechanisms to communicate stroke treatment outcomes to medical staff at all levels. Our stroke coordinator meets regularly with all medical staff involved after a treated case to provide feedback. We have regularly scheduled multidisciplinary stroke meetings where successes are shared and opportunities are discussed. We have scheduled stroke quality meetings to discuss opportunities and communicate with staff involved. Results: As a result of constant surveillance, our door to needle (DTN) times have continued to go down, most recently to 42.9 minutes (graph). The number of patients treated with IV-tPA increased from 5% to 14% following implementation of value stream technology, and is currently at 15%. The percent of patients treated within the golden hour has continued to rise, and has now reached 78%. Conclusions: Improved outcome measures in acute stroke can be maintained and further improved by regular communication and feedback provided to all members of the stroke team. This fosters a competitive spirit and a sense of ownership that helps to sustain the process. Through this effort we continue to see increases in the number of patients treated and a reduction in treatment times.

Abstract WP241: Value Stream Analysis Reduces Door-To-Needle Times in Acute Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Abdeljalil Bentaleb ◽  
Larisa Golding ◽  
Susan Southee ◽  
Lewis B Eberly
Keyword(s):  
Acute Stroke ◽  
Patient Flow ◽  
Wait Time ◽  
Process Time ◽  
Important Goal ◽  
Stroke Patients ◽  
Golden Hour ◽  
Value Stream ◽  
Number Of Patients ◽  
Iv Tpa

Introduction: An important goal in treating acute stroke is minimizing door-to-needle times, consistent with evidence based practice and quality goals. Utilizing methods to streamline the process of patient and information flow in the emergency department (ED) is necessary to reduce treatment times. Hypothesis: Use of value stream analysis to improve efficiency in processing acute stroke patients in the ED should reduce door-to-needle times. Methods: Value stream is the movement of patient and information to deliver the desired outcome. The process from door to treatment was divided into individual steps. We defined process time (the time each step takes) and wait time (the time between each step). The mission was to identify which steps were absolutely necessary before a patient could receive IV-tPA, and to streamline those steps to reduce the process time. All patients who received IV-tPA in 2011 and thus far in 2012 are shown in the graph. Each bar represents an individual patient. Results: Prior to stream analysis, our average door-to-needle time was 122.2 minutes. After the process was rolled-out, the average door-to-needle time was down to 73.8 minutes. Before stream analysis we treated 7.6% of our IV-tPA patients in less than 60 minutes. After analysis we treated 69.2% of patients in less than 60 minutes. The number of patients treated rose from 11 in 2011 (5%) to 17 thus far in 2012 (mid-year, projected 15%). We also found that the number of thrombectomy treated patients was reduced from 39% prior to analysis to 23% following analysis, perhaps partly due to reduced processing time and more patients evaluated within the window for IV-tPA. Conclusion: Streamlining the process of patient flow in the ED by value stream analysis resulted in several outcome improvements in acute stroke patients: 1) Reduced door-to-needle times. 2) Increased number of patients treated within the golden hour. 3) Increased number of patients treated with IV-tPA.

scholarly journals The Investigation on the Burden of Neurology Residents to Manage the Patient who Received Thrombolytic Treatment in the Emergency Department with Hyperacute Stroke

2021 ◽  
Vol 39 (4) ◽  
pp. 305-311
Author(s):  
Hyun Joon Lee ◽  
Dong Hoon Shin ◽  
Kwang Ik Yang ◽  
Im-Seok Koh ◽  
Kyung Bok Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Teaching Hospitals ◽  
Stroke Patients ◽  
Stroke Incidence ◽  
Average Hospital ◽  
Stroke Treatment ◽  
Hyperacute Stroke ◽  
Number Of Patients ◽  
Hospital Beds

Background: Because Korea is the fastest aging country, the stroke incidence is increasing rapidly. We investigate the trend of the number of patients with acute stroke in recent years and estimate the burden of the neurologist to treat the acute stroke patient visited the emergency department.Methods: We requested a questionnaire survey to all teaching hospitals on the number of hospital beds, the number of stroke patients who visited the emergency department, the number of stroke patients in charge of the neurologist, and the number of days on duty of residents from 2016 to 2019.Results: Of 69 teaching hospitals, 41 hospitals answered the survey. The average hospital beds per hospital were increased annually from 909 to 916. The average patients who visited the emergency department with stroke and were in charged to neurologists were rapidly increased from 799 to 867 per hospital. In particular, the number of patients with hyperacute cerebral infarction requiring the thrombolytic administration or mechanical thrombectomy were rapidly increased from 105 to 131. On the other hand, the average number of residents per hospital was decreased from 5.1 to 4.8. Therefore, the days on duty per resident were increased from 74 to 77.Conclusions: The number of acute stroke patients, especially, hyperacute stroke required the rapid cooperation and high labor were increasing rapidly in recent years. However, because the number of residents were decreased, the burden was increasing. To improve the quality of acute stroke treatment, it is necessary to increase the number of residents.

Abstract WP244: The Stroke Interventional Radiology (SIR) Process for Rapid Transport of the Acute Stroke Patient

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
JJ Baumann ◽  
Carol Barch ◽  
Robert Dodd ◽  
Mary Marcellus ◽  
Maarten Lansberg
Keyword(s):  
Interventional Radiology ◽  
Acute Stroke ◽  
Interventional Neuroradiology ◽  
Expert Advice ◽  
Time Of Arrival ◽  
Coordinated Care ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Interventional Neuroradiologist ◽  
Number Of Patients

Background: Expedient transfer of acute stroke patients is imperative for optimizing stroke treatment. Our aim was to develop and evaluate a new process that would provide rapid accessibility to expert advice, multi modality imaging, and interventional stroke treatments. Methods: In October 2008, members from Interventional Neuroradiology and Stroke neurology identified obstacles that led to delays in acceptance and transfer of patients. the Stroke Interventional Radiology (SIR) processwas developed to streamline the transfer of acute stroke patients. Results: Before implementation of the SIR process, numerous calls were made to arrange for coordination of care. Communication between the referring physician, stroke neurologist and neuro-interventionalist occurred sequentially. Once a decision was made to accept the patient for transfer, checking for bed availability before approval of the transfer created additional delays. In May 2009, the SIR process was developed to improve rapid access. The process involves coordinated care among the neuro-interventionalist, stroke neurologist, transfer center, hospital administration, radiologist, radiology techs, and crisis nurses and has three main components: 1)the neurologist and interventional neuroradiologist are jointly connected via conference call with the referring physician within five minutes, 2) bed availability for acute stroke transfers is guaranteed, and 3) a paging system provides communication to physicians, nurses, radiology technologists, transport team, and respiratory therapist on patient condition and estimated time of arrival. Since implementation, total time to transfer approval has decreased by 75%. Simultaneously, we have increased the volume of patients transferred (38 in 2010, 59 in 2011 and 21 for first quarter of 2012), the number of acute stroke patients treated with intervention (10, 13, 16, 17 for consecutive years from 2008), and, via phone consultation, the number of patients treated with IV tPA at referring hospitals (3, 2, 19, 28, for consecutive years since 2008 and 12 already for first quarter of 2012). Conclusion: A system of coordinated care can markedly reduce acute stroke transfer times.

Improving Efficiency and Patient Satisfaction in a Peripherally Inserted Central Catheter Center Using Lean-Based Methodology

2014 ◽  
Vol 19 (4) ◽  
pp. 244-255 ◽  
Author(s):  
Ying Zhu ◽  
Zhenqi Lu ◽  
Hongqin Dai
Keyword(s):  
Lean Manufacturing ◽  
Value Stream Mapping ◽  
Cancer Center ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Value Stream ◽  
Root Cause ◽  
Number Of Patients ◽  
Future Value ◽  
Value Stream Map

Abstract Background: The peripherally inserted central catheter implantation and maintenance process was optimized at Shanghai Fu Dan University Cancer Center using lean-based methodology. Problems addressed were coping with capacity limitations and streamlining the process of patient care to reduce potential complications associated with delays in catheter administration. These clinical processes were evaluated with regard to pretreatment areas—such as booking, waiting, and patient education—and solutions were recommended to the problems that were identified. Methods: Lean methodology was used under actual clinical settings to improve the clinical process, using observations, patient surveys, interviews, data analysis, and a kaizen workshop. Three tools were applied from lean methodology: value stream mapping, bottleneck calculation, and fishbone root cause analysis. The philosophy of kaizen was used to enhance teamwork, boost morale, and encourage all members of the frontline nursing team and administration leaders to contribute ideas and suggestions for improvement. Results: A value stream map and a redesigned future value stream map were plotted at the workshop to identify problems related to inefficiency and waste and to aid in proposing solutions. Implementation of these solutions resulted in smooth and steady patient distributions on days with the largest patient volume during a typical week and an increase of 30% in the number of patients that could be seen in a week. Conclusions: The economic methodology of lean manufacturing, especially value stream mapping, can be a powerful tool for visualizing and better understanding processes to reduce waste and reengineer a standardized workstream in settings where peripheral intravenous central catheters are placed.

Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
RAJAN R GADHIA ◽  
Farhaan S Vahidy ◽  
Tariq Nisar ◽  
Destiny Hooper ◽  
David Chiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Combined Treatment ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Acute Stroke Treatment ◽  
Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Shlee Song ◽  
Nili Steiner ◽  
Betty Robertson ◽  
Nicole Wolber ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Turnaround Time ◽  
Joint Commission ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Introduction/Background information: At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5 th hospital in the nation to receive this certification. Researchable question: Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care? Methods: We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time. Results: In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC). Conclusion: We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.

Abstract TP205: Clinical Aspects Of First-ever Stroke In Patients With Permanent Pacemaker

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jiro Kitayama ◽  
Hiroshi Nakane ◽  
Hiromi Ishikawa ◽  
Masahiro Shijo ◽  
Masahiro Kamouchi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Pacemaker Implantation ◽  
The United States ◽  
Permanent Pacemaker ◽  
Stroke Onset ◽  
Clinical Aspects ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Stroke Registry ◽  
History Of

OBJECTIVES: Recently, increasing numbers of patients take pacemaker implantation: almost sixty thousands in Japan, and no less than two hundreds of thousands in the United States per year. Previous reports have indicated that prevalence of atrial fibrillation (Af) is high, and several coagulation markers are elevated in those with pacemaker. However, the precise features of stroke with implanted device are not clear. We, thus, examined the clinical aspects of stroke in pacemaker patients. METHODS: For the present study, we analyzed data from the Fukuoka Stroke Registry that is a multicenter epidemiological study database on acute stroke. From June 1999 to May 2011, 11376 ischemic stroke patients (72±12 years of age, female/male=4613/6763) who admitted to the hospital within seven days after onset were enrolled in the registry. Stroke subtypes were classified according to the diagnostic criteria of TOAST (Trial of Org 10172 in Acute Stroke Treatment). RESULTS: A total of 207 patients (1.8% of registered stroke patients) were with pacemaker. Among them, 130 patients had no history of any stroke. They appeared to be a mean age of 81±9 (range 42 to 97) years, and female/male ratio of 77/53. Mean duration from pacemaker implantation to stroke onset was 8±7 (median 6, quartile 3-11) years. 32 patients (25%) were given oral anticoagulant prior to stroke onset; 60 (46%) were on antiplatelet. Prevalence of Af in pacemaker patients was 48% (n=63). In those with Af, 48 patients (76%) were diagnosed as cardioembolic stroke, but only 22 (35%) were on anticoagulation before onset. Even in those without Af, 33 cases (49%) were also diagnosed as cardioembolic. The percentage of subjects with increased plasma D-dimer (≥1.5 μg/ml) was significantly higher in pacemaker group than no-pacemaker group, regardless of the presence or absence of Af (75% vs. 45% with Af; p<0.0001, 74% vs. 25% without Af; p<0.0001). CONCLUSIONS: In our current study, stroke in pacemaker patients revealed to have higher incidence of cardiogenic embolism, with or without Af. In addition, the majority was elderly, and failed to receive anticoagulant prior to stroke. It is needed to re-consider therapeutic strategy, including anticoagulation, for prevention of stroke in those with permanent pacemaker.

scholarly journals Assessing the Use of Standardized Outcome Measures for Stroke Rehabilitation among Physiotherapists in Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Seth Kwame Agyenkwa ◽  
Cosmos Yarfi ◽  
Adjoa Nkrumah Banson ◽  
Woyram Abla Kofi-Bediako ◽  
Ulric Sena Abonie ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Outcome Measures ◽  
Stroke Rehabilitation ◽  
Good Clinical Practice ◽  
Stroke Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Allied Health Professions ◽  
Frequency Of Use ◽  
Number Of Patients

Background. The use of standardized outcome measures is an aspect of good clinical practice and essential to the rehabilitation of patients suffering from stroke. Literature reports regarding the extent of usage of outcome measures in stroke rehabilitation by physiotherapists globally are inconsistent. In addition, the patronage of outcome measures in stroke rehabilitation in low-resourced countries is uncertain. Objective. This study was conducted to assess the current practice of physiotherapists in Ghana regarding the use of standardized outcome measures in the rehabilitation of stroke patients. Method. A descriptive cross-sectional survey, was used involving 105 registered physiotherapists in Ghana. A 35-item adapted questionnaire was used to collect data on some commonly used outcome measures and frequency of use by physiotherapists for stroke patients. Results. A total of 55 (52.4%) physiotherapists did not use outcome measures in their clinical practice. Physiotherapists below 40 years of age use outcome measures (64.7%) more than those 41 years and above (6.7%). Physiotherapists working in public facilities in Ghana are more likely to use outcome measures (56.2%) than those in private facilities (16.2%). Physiotherapists who attend to 1-10 patients in a week used outcome measures more (32.4%) than physiotherapists who attend to more than 30 patients (3.8%) in a week. Conclusion. There is poor usage of outcome measures by Ghanaian physiotherapists, with more than half of the participants not using any standardized outcome measures for rehabilitation of patients in their practice. Physiotherapists who attends to fewer number of patients in a week are more likely to use outcome measures. There is the need for implementation of policy and guidelines on the use of outcome measures by the Allied Health Professions Council and the Ghana Physiotherapy Association.

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