Abstract WP472: Improving Neurologic Follow-Up After Stroke Utilizing a Nurse Practitioner
Background: Patients who experience acute ischemic stroke are at increased risk for a secondary vascular event. Risk factor management as well as review of the medication regimen are important components to secondary prevention. Neurologic follow-up is an essential step during transitions of care to ensure these components are addressed. For a variety of reasons, stroke patients do not always complete follow up appointments. The literature suggests that such patients are at increased risk for readmission. Purpose: The purpose of this project was to improve access to neurologic follow-up for patients diagnosed with acute ischemic stroke after discharge from an acute care or rehabilitation setting. The secondary goal was to decrease readmission rates. Methods: A nurse practitioner (NP) was added to the inpatient stroke neurology service. The model of care was redesigned with the NP performing subsequent assessments after the initial evaluation was completed by the neurologist. The NP also organized the plan of care, including appropriate post discharge follow-up. Over time, due to challenges with access to appointments, the NP started an outpatient stroke clinic. Data were entered into Get With The Guidelines®-Stroke to identify the patients who had a neurology provider appointment scheduled prior to hospital discharge, regardless of discharge disposition. Results: Between the first quarter of 2018 and the second quarter of 2019, the percentage of patients with a neurologic follow-up appointment scheduled prior to hospital discharge improved from 23% to 61%. During this same time period, the readmission rates decreased from 14% to 9%. Conclusions: Adding the NP position to an inpatient stroke neurology service and using this role to lead an outpatient stroke clinic improves the percentage of patients who have appointments scheduled prior to hospital discharge. Improving access to follow-up care influences readmission rates.