Abstract TP380: Improving Outcomes for Stroke Patients at Risk for Cognitive and Mood Impairments

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sanny Djoeva ◽  
Melissa N Lara-Angulo
Keyword(s):  
Quality Improvement ◽  
Cognitive Decline ◽  
Medical Center ◽  
Academic Medical Center ◽  
Quality Improvement Project ◽  
Provider Education ◽  
Stroke Patients ◽  
Post Intervention ◽  
Improvement Project ◽  
Referral Compliance

Background: Improved survival rates of stroke patients have resulted in a rise in disability within this population. Research demonstrates that stroke patients are at high risk for cognitive decline and depression. Neuropsychological intervention can improve outcomes for this population. At an academic medical center in the Midwest, the process in which stroke patients are screened for these impairments and subsequently referred to a neuropsychologist is ineffective. Purpose: The purpose of this quality improvement project was to critically appraise the process in which stroke patients are screened for cognitive decline and depression and to improve the process using a multi-disciplinary approach of nursing, medicine, rehabilitation and neuropsychology. Methods: A total of 231 patient charts were reviewed in this quality improvement project. The Plan-Do-Study-Act model was utilized. Process changes included: provider education on order placement of neuropsychology referrals, occupational therapist education on correct progress note use, and improvement of visibility of the stroke patient list to screening staff. Pre- and post-intervention data were examined to assess for changes in screening compliance and consultations. Results: Baseline data collected December 2016 showed 64% compliance with Montreal Cognitive Assessment (MoCA) screening, 50% compliance with Patient Health Questionnaire (PHQ-2) screening, and 50% compliance with neuropsychology referral. After new processes were implemented, April 2016 data showed 100% MoCA compliance, 95% PHQ-2 compliance, and 100% neuropsychology referral compliance. Although these numbers look promising, we will continue to gather and analyze data to ensure this positive compliance trend continues. Conclusion: Multidisciplinary education and increased visibility of stroke patients requiring a screening may increase compliance of cognitive decline and depression screening as well as subsequent referral to neuropsychology. The increase in screening compliance will ultimately lead to appropriate referrals and further resources for the stroke population.

scholarly journals Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

2013 ◽  
Vol 93 (7) ◽  
pp. 975-985 ◽  
Author(s):  
Heidi J. Engel ◽  
Shintaro Tatebe ◽  
Philip B. Alonzo ◽  
Rebecca L. Mustille ◽  
Monica J. Rivera
Keyword(s):  
Quality Improvement ◽  
Physical Therapy ◽  
San Francisco ◽  
Physical Therapist ◽  
Medical Center ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Icu Admission ◽  
Number Of Patients

Background Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. Objective The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. Design This study was a 9-month retrospective analysis of a quality improvement project. Methods An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. Results From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. Limitations This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. Conclusions The improvements in outcomes demonstrated the value and feasibility of a physical therapist–led early mobilization program.

Improving veteran access to lung cancer care (IVaLuCancerCare): A quality improvement project at the Louis Stokes Cleveland VA Medical Center (LSVAMC).

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. 6530-6530
Author(s):  
Rami Manochakian ◽  
Jennifer Smith ◽  
Stephanie Mervar ◽  
Deborah Fox ◽  
Kauzy Woods ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Quality Improvement ◽  
Cancer Care ◽  
Medical Center ◽  
Quality Improvement Project ◽  
Improvement Project
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