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

Stroke ◽  
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.

scholarly journals Stroke Patient Outcomes in US Hospitals Before the Start of the Joint Commission Primary Stroke Center Certification Program

Stroke ◽  
2009 ◽  
Vol 40 (11) ◽  
pp. 3574-3579 ◽  
Author(s):  
Judith H. Lichtman ◽  
Norrina B. Allen ◽  
Yun Wang ◽  
Emi Watanabe ◽  
Sara B. Jones ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Stroke Patient ◽  
Joint Commission ◽  
Certification Program ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Joint Commission

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

Stroke ◽  
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.

Abstract WP435: Post Procedural Monitoring Tool Improves the Joint Commission Comprehensive Stroke Center Standard Compliance

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Denise Gaffney ◽  
Lorina Punsalang ◽  
Alvina Mkrtumyan ◽  
Raeesa Dhanji ◽  
David McCartney ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Electronic Monitoring ◽  
Vital Signs ◽  
Joint Commission ◽  
Monitoring Tool ◽  
Post Intervention ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa ◽  
The Joint Commission

Background: The Joint Commission (TJC) Comprehensive Stroke Center standard requires monitoring of patients after IV tPA administration, diagnostic angiography, aneurysm coiling, carotid angioplasty and stenting, mechanical endovascular reperfusion (MER) and carotid endarterectomy. Meeting 100% compliance of the standard is challenging. In 2018, monitoring and documentation were among the TJC’s top ten cited survey findings. Purpose: To determine if an electronic tool can improve documentation compliance and reduce delays in monitoring of vital signs, and neurologic, pedal pulse and skin site assessments. Methods: The initiative was implemented in 2018 with the objective for all patients to have 100% of their post procedural monitoring completed. A documentation tool was created and introduced to nursing units via annual stroke education updates. The tool was added to an online nursing resource SharePoint website and application, which was accessible to all nurses within the hospital. The procedure end time was entered in the tool, which automatically calculated the documentation times. Data was compared 12 months pre and post intervention. Analysis and reporting of data were conducted monthly via the program’s quality oversight committee. Data was analyzed using T-Test. Results: In post-IV tPA patients, more patients had 100% complete documentation (79% post vs. 29% pre-implementation; p=0.006). For all post neuro-interventional radiology procedures, more patients had 100% complete documentation (68% post vs. 17% pre-implementation; p<0.001). For post carotid endarterectomy revascularization, there was a trend toward more patients with 100% complete documentation (83% vs 38%; p=0.07). Conclusion: Utilization of an electronic monitoring tool for post procedural documentation adherence can improve the percentage of patients who have 100% completed assessments and help meet the TJC standard.

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

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mary Ann Blosky ◽  
E. Andrew Raposo
Keyword(s):  
Program Development ◽  
Medical Center ◽  
Clinical Signs ◽  
The State ◽  
Joint Commission ◽  
High Performing ◽  
Time Of Application ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
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.

Abstract TP3: What Hospital Characteristics Drive Faster Thrombectomy For Emergent Large Vessel Occlusion (ELVO)?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason Tarpley ◽  
Lindsay Lucas ◽  
Joseph T Ho ◽  
Renee Ovando ◽  
Elizabeth Baraban
Keyword(s):  
Arrival Time ◽  
High Volume ◽  
Reperfusion Therapy ◽  
Multivariate Logistic Regression Model ◽  
Vessel Occlusion ◽  
Stroke Registry ◽  
Primary Stroke Center ◽  
Treatment Volume ◽  
Transferred Patients ◽  
Stroke Center

Introduction: Recent thrombectomy trials for ELVO have reverberated the importance of speed in reperfusion therapy. Identifying hospital practices and features associated with faster door to thrombectomy times is critical to evolving our hospital systems to effectively deliver this powerful therapy. Methods: A multi-hospital, Get with the Guidelines stroke registry was used to identify AIS patients who received intra-arterial (IA) intervention between January 2012 and May 2016. Transferred patients were excluded since their door to reperfusion times don’t typically include a primary evaluation. Patients were categorized as having door to reperfusion (Door-to-IA) time over 135 minutes or Door-to-IA time below or equal to 135 minutes. A multivariate logistic regression model was used to identify which of the following variables were associated with Door-to-IA times over 135 minutes: age, gender, IV alteplase treatment, admit NIHSS score, patient arrival time to hospital, hospital certification (primary stroke center (PSC) versus comprehensive stroke center (CSC)), hospital annual IA treatment volume, and hospital annual percentage of transfers for thrombectomy. Results: We identified 229 AIS patients from ten hospitals who received IA intervention between January 2012 and May 2016. Of those, 49% (n=113) had Door-to-IA times over 135 minutes and 51% (n=116) had Door-to-IA time below or equal to 135 minutes. Patients with Door-to-IA times over 135 minutes were more likely to be older (adjusted odds ratio (AOR) = 1.02 per year; p=.040), treated at a PSC (AOR = 2.26; p=.028), and treated at a hospital with a higher percentage of transfers (AOR = 1.08 per percentage point; p<.001). IV-alteplase treatment, gender, NIHSS, patients’ arrival time and volume were not significant. Conclusion: Comprehensive stroke centers had shorter Door-to-IA times than Primary Stroke Centers in our system. However, hospital annual IA treatment volume did not impact Door-to-IA and centers with larger transfer volume actually had worse Door-to-IA times for patients evaluated and treated locally. This suggests that high volume centers with a larger volume of transferred patients may have tuned their practices to treating transfers rather than treating local ELVO patients.

scholarly journals Thrombectomy accessibility after transfer from a primary stroke center: Analysis of a three-year prospective registry

2017 ◽  
Vol 12 (5) ◽  
pp. 519-523 ◽  
Author(s):  
Denis Sablot ◽  
Nicolas Gaillard ◽  
Philippe Smadja ◽  
Jean-Marie Bonnec ◽  
Alain Bonafe
Keyword(s):  
Symptom Onset ◽  
Mechanical Thrombectomy ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
Interventional Neuroradiology ◽  
High Volume ◽  
Large Artery ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background No comprehensive study exists about mechanical thrombectomy accessibility for patients admitted to a primary stroke center without onsite interventional neuroradiology service. Aims To evaluate mechanical thrombectomy accessibility within 6 h after transfer from a primary stroke center to a distant (156 km apart; 1.5 h by car) comprehensive stroke center. Methods Analysis of data collected in a three-year prospective registry on patients admitted to a primary stroke center within 4.5 h after symptom onset and selected for transfer to a comprehensive stroke center for mechanical thrombectomy. Eligible patients had confirmed proximal arterial occlusion and no large cerebral infarction on MRI images (DWI-ASPECTS ≥ 5). The rate of transfer, transfer without mechanical thrombectomy, mechanical thrombectomy, reperfusion (TICI score ≥ 2b-3), and the main relevant time measures were determined. Results Among the 385 patients selected for intravenous thrombolysis and/or potential mechanical thrombectomy, 211 were considered as transferrable for mechanical thrombectomy. The rate of transfer was 56.4% (n = 119/211), transfer without mechanical thrombectomy 56.3% (n = 67/119), mechanical thrombectomy 24.6% (n = 52/211), and reperfusion by MT (TICI score 2b/3) 18% (n = 38/211). The relevant median times (interquartile range) were: 130 min (62) for intravenous thrombolysis start to comprehensive stroke center door, 95 minutes (39) for primary stroke center door-out to comprehensive stroke center door-in, 191 min (44) for intravenous thrombolysis start to mechanical thrombectomy puncture, 354 min (107) for symptom onset to mechanical thrombectomy puncture and 417 min (124) for symptom onset to recanalization. Conclusions Our study suggests that transfer to a distant comprehensive stroke center is associated with reduced access to early mechanical thrombectomy in patients with acute ischemic stroke and large artery occlusion. These results could be translated to other high volume distant primary stroke center.

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

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3387-3391 ◽  
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

scholarly journals Shortening time to reperfusion after transfer from a primary to a comprehensive stroke center

2019 ◽  
Vol 9 (5) ◽  
pp. 417-423 ◽  
Author(s):  
Denis Sablot ◽  
Geoffroy Farouil ◽  
Alexandre Laverdure ◽  
Caroline Arquizan ◽  
Alain Bonafe
Keyword(s):  
Clinical Characteristics ◽  
Mechanical Thrombectomy ◽  
High Volume ◽  
Reperfusion Therapy ◽  
Mri Imaging ◽  
Interhospital Transfer ◽  
Primary Stroke Center ◽  
Speed Up ◽  
Comprehensive Stroke Center ◽  
Stroke Center

BackgroundThis study assessed whether a quality improvement (QI) process to streamline transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) could reduce the delay of reperfusion by mechanical thrombectomy (MT).MethodsFrom 2015 to 2017, a QI process was implemented with specific interventions to reduce door-in-to-door-out (DIDO) time in a high volume PSC, and speed up interhospital transfer and inhospital processes at the CSC. Clinical characteristics and time metrics were compared in the QI (2015–2017; n = 157) and pre-QI cohorts (2012–2014; n = 121).ResultsDuring the QI process, the median symptom onset to reperfusion time was reduced by 50 minutes (367 vs 417 minutes in the pre-QI cohort, p < 0.04), with a substantial 40-minute DIDO reduction (78 vs 118 minutes, p < 0.01), related to the faster administration of IV thrombolysis (median door-to-needle time: 49 vs 82 minutes, p = 0.0001). The door-to-door time was shortened (170 vs 205 minutes, p = 0.002), but not the transfer time (92 vs 87 minutes, p = 0.5). The QI process had no effect on the prehospital phase (77 vs 76 minutes, p = 0.83) and on the time from MRI imaging at the PSC to reperfusion (252 vs 288 minutes, p = 0.12). The rate of modified Rankin Scale score 0–2 at 90 days was comparable in the pre-QI and QI cohorts.ConclusionsA QI process can reduce the reperfusion therapy delay in a distant CSC; however, we could not demonstrate that it can also improve the outcome of patients who undergo MT.

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

Neurology ◽  
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

Abstract WP359: Achieving Target: Stroke Honor Roll Status through the Utilization of 9 Best Practice Strategies

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jennifer Garland
Keyword(s):  
Brain Imaging ◽  
Best Practice ◽  
Rapid Acquisition ◽  
Rapid Access ◽  
Honor Roll ◽  
Stroke Team ◽  
Data Feedback ◽  
National Quality ◽  
Primary Stroke Center ◽  
Stroke Center

Background: Target: Stroke is a national quality initiative of the American Heart Association/American Stroke Association with the goal of improving <60 minute door-to-needle times (DTN) for at least 50% of patients receiving IV rt-PA. (AHA/ASA, 2012) Purpose: To improve DTN times <60 minutes at an urban Primary Stroke Center in South California through the utilization of the Target: Stroke national quality initiative. Methods: Retrospective data analysis for 11 IV rt-PA receiving patients in the Get With The Guidelines-Stroke (GWTG-Stroke) database from 11/01/2011 to 01/31/2012. Employment of 9 Target: Stroke Best Practice Strategies: Advance Hospital Notification by EMS (Emergency Medical Services), Rapid Triage Protocol and Stroke Team Notification, Single Call Activation System, Stroke Tools, Rapid Acquisition and Interpretation of Brain Imaging, Rapid Laboratory Testing, Rapid Access to Intravenous IV rt-PA, Team-Based Approach, and Prompt Data Feedback. Results: The hospital received advanced hospital notification by EMS for 10 out of 11 (90.9%) IV rt-PA receiving patients. 100% of the patients were rapidly triaged, the stroke team was notified via single call activation & overhead page (stroke alert), and the appropriate thrombolytic stroke order sets were implemented (Stroke Tools). Rapid acquisition and interpretation of brain imaging were measured. CT Scan order to CT complete turn-around-time (TAT) averaged 12 minutes. CT Complete to CT Read TAT averaged 11.33 minutes.Average PT/INR and PTT TATs were 26.1 minutes. Rapid access to intravenous IV rt-PA was mixed by the Emergency Department pharmacist at the bedside for 100% of patients. The Team-Based Approach and prompt Data Feedback were practiced by holding monthly Stroke Steering Committee meetings that included interdisciplinary team members and disseminating data. Eight out of eleven (72.7%) acute ischemic stroke patients treated with IV rt-PA received the medication <60 minutes. Median door-to-needle (DTN) time for patients treated with IV rt-PA: 42 minutes. Conclusion: By employing 9 Target: Stroke Best Practice Strategies at an urban Primary Stroke Center in South California, the hospital was able to achieve Target: Stroke Honor Roll status from 11/01/2011 to 01/31/2012.

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