Abstract P120: The Covid Effect on Stroke Response

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kiffon M Keigher ◽  
Demetrius Lopes ◽  
Tim Mikesell ◽  
Lynn Klassman ◽  
Minna B Masor ◽  
...  
Keyword(s):  
Stroke Care ◽  
Healthcare Systems ◽  
Adverse Outcomes ◽  
Model Of Care ◽  
Team Members ◽  
Program Leaders ◽  
Alternative Placement ◽  
Management Plans ◽  
Hospital Teams ◽  
Multiple Patients

Background & Significance: The Covid-19 pandemic has created a host of challenges for healthcare systems and hospital teams that have put unprecedented stress on staff and leaders to re-design care and management of not only the Covid positive patient but also the hospitalized non-Covid patient. As this large healthcare system began to prepare for a Covid surge of patients, stroke program leaders recognized the need for alternative placement and management plans. With the re-designation of units and beds and deployment of staff into non-primary units, program leaders were concerned with not only placement of stroke patients outside of regular stroke and Neurocritical Care Units but also with non-trained stroke nursing staff caring for the patient. In response, this stroke program convened a working group to create alternative guidelines for care of the stroke patient during Covid surge and critical bed shortages. Design & Methods: The need for established criteria to guide all sites in the care of patients post IV thrombolytic or mechanical thrombectomy was the key objective. The alternative guideline was drafted and submitted to the system Covid clinical command center for emergent approval. Once approval given, education was provided to all stroke coordinators and key leaders at each site. To provide full access, guidelines were posted and available on the system SharePoint site for access to all team members. Results: The drafting of alternative stroke guidelines allowed for improved patient safety during our 27-hospital healthcare systems Covid surge. Care of multiple patients occurred outside normal critical care and stroke units with a decreased number of assessments for patients from the standard, pre-Covid and without increase safety events or adverse outcomes. The success of the alternative guidelines and this Covid effect on stroke care management not only helped our staff and patients during a time of need in safe care but also provided a new model of care for our stroke program leaders to consider and implement across our organizations.

Abstract WMP68: Smartphone Support System for Mobile Imaging Display and Management of Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kristina Shkirkova ◽  
Eftitan Y Akam ◽  
Josephine F Huang ◽  
Sunil A Sheth ◽  
May Nour ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Integrated System ◽  
Ease Of Use ◽  
Imaging Data ◽  
Acute Stroke Care ◽  
Team Members ◽  
Information Platform ◽  
Stroke Team

Introduction: Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members is essential for optimal acute stroke care. Standard desktop EMRs are ill-suited for this purpose, but mobile smartphone and tablet applications are highly promising platforms for accelerated, data-driven patient diagnosis and treatment. This study tested an advanced mobile integrated system for distribution of patient clinical and imaging information. Methods: We tested the iStroke/Synapse ERm system (Figure) for smartphone and tablet display and integration of clinical data, CT, MR, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results: From 5/2014 to 10/2014, the Synapse ERm application was installed and used by 33 stroke team members, in 84 Code Stroke ED patients. Patient age was 69.1 (±17.5), with 40.5% female. Final diagnosis was: ischemic stroke 66%, TIA 7%, ICH 6%, and CV mimic 21%. Each patient record was viewed on average 13 times by at least 3 team members. The most used feature was CT, MR and cath angio image display, viewed on average 4 times per patient by at least 2 users. In-app tweet team communications were sent by average 2 users per case and viewed by average 6 team members. Use of the system was associated with treatment times that exceeded national guideline targets for thrombolysis and endovascular thrombectomy, including door-to-needle 50 min (IQR 24-60) and door-to-groin 92 min (IQR 65-128). In user surveys, the mobile information platform was judged easy to employ in 91% of uses and of added help in stroke management in a substantial majority of cases. Conclusion: The Synapse ERm system, a smartphone/tablet platform for stroke team communication and distribution and integration of clinical and imaging data, showed high ease of use, substantial added management value, and association with rapid processes of care.

Teaching a DISCHARGE Framework to Hospital Teams to Improve Transitions of Care

2020 ◽  
Author(s):  
Shreya P. Trivedi ◽  
Mack Lipkin ◽  
Mark D. Schwartz
Keyword(s):  
Ad Hoc ◽  
Discharge Planning ◽  
Transitions Of Care ◽  
Hospital Discharges ◽  
Patient Centered ◽  
Team Members ◽  
Informal Curriculum ◽  
Discharge Plan ◽  
Perceived Change ◽  
Hospital Teams

Abstract Background: Residents typically learn about managing transitions of care as part of the informal curriculum in an ad-hoc, reactive manner. Learning may be enhanced by using a framework to proactively practice addressing key domains for a patient soon-to-be-discharged from the hospital. We developed such an evidence-based framework, DISCHARGE , as a cognitive aid. Using this framework, we implemented and evaluated a workshop designed for hospital teams to learn addressing key components of discharging a patient.Methods: All members of 8 Internal Medicine teams across 4 rotations were invited to attend an hour-long workshop ranging from September 2017 - February 2018. Participants completed a retrospective, pre-post survey on their perceived change in discharge-related behaviors. We evaluated the perceived effectiveness of the workshop with a retrospective pre-post questionnaire. We used Wilcoxon signed-rank tests for pairwise comparisons to access perceived changes in discharge behaviors.Results: A total of 90 of 140 team members (64%) attended the workshop and 79 of the 90 (87%) completed the questionnaire. The session was effective in increasing the likelihood of addressing patient-centered behaviors at discharge (mean 1.4 improvement on a 5-point scale, P<0.001, R>0.5). In addition, senior residents and attendings projected they were more likely to discuss the importance of discharge planning with the team early in a rotation. Interns noted they were more comfortable asking the team for help in carrying out a discharge plan (p<0.001, R>0.5).Conclusions: Teaching teams a cognitive aid to practice managing hospital discharges may increase the likelihood of addressing important domains for their patients. Incorporating the team allows for explicit alignment for priorities and communication. Further study is needed to document how such learning is translated into discharge practice.

scholarly journals Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

2020 ◽  
Author(s):  
Andrew C. Nixon ◽  
Julie Brown ◽  
Ailsa Brotherton ◽  
Mark Harrison ◽  
Judith Todd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Screening Programme ◽  
Management Plan ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Quality Improvement Project ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Management Plans

Abstract Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

scholarly journals Mutual relationship between heart failure and atrial fibrillation

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Filippo M. Sarullo ◽  
Giuseppe Schembri ◽  
Cinzia Nugara ◽  
Silvia Sarullo ◽  
Giuseppe Vitale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Health Care Expenditure ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Healthcare Systems ◽  
Adverse Outcomes ◽  
Evidence Based ◽  
Potential Treatment ◽  
The Common

Atrial fibrillation (AF) and heart failure (HF) are evolving epidemies, together responsible for substantial human suffering and health-care expenditure. The simultaneous co-hexistence of the two conditions is associated with mortality rates higher than those observed in individuals with only one or none of them. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies. Recent data have suggested that these patients may respond differently if compared to those with HF or AF alone. These results highlight the clear clinical need to identify and treat these diseases according to best evidence, in order to prevent adverse outcomes and reduce the huge burden that HF and AF are expected to have on global healthcare systems in the future.

Refining the clinical trials assessment of infrastructure matrix tool.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 230-230
Author(s):  
Bryan Weiner ◽  
Randall Teal ◽  
Eileen P. Dimond ◽  
Marjorie J. Good ◽  
Angela Carrigan ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Best Practice ◽  
Research Performance ◽  
Cognitive Interviews ◽  
Clinical Practices ◽  
Scoring Method ◽  
Team Members ◽  
Program Leaders ◽  
Don't Know Responses ◽  
Community Input

230 Background: Many community cancer research programs aim to exceed Good Clinical Practices. To support such efforts, the National Cancer Institute and collaborators began developing the Clinical Trials Assessment of Infrastructure Matrix (CT AIM) Tool in 2008. CT AIM’s 3 levels of exemplary performance span 11 infrastructure attributes. 2013’s revisions focused on interpretability, usability, and measurability. Methods: Tool input was obtained at national research meetings. Also, 4 Principal Investigator-Program Administrator (PI/PA) pairs from NCI-funded community cancer programs with varied demographics (eg, size, population) underwent cognitive interviews. Aggregated responses and a major-themes summary led to tool revisions. Next a web-based version was piloted with 4 more PI/PA pairs. The frequency/distribution of responses within pairs was assessed. The revised tool was then field-tested with 9 more PIs and scoring method feedback was collected; the tool was further revised. Results: Per community input and cognitive interviews: (1) “best practice” designation was replaced with “assessment of infrastructure”, (2) attributes were reordered based on perceived importance, (3) terms and cumulativeness of levels were clarified. Receiving 0 “don’t understand”s indicated improvement in clarity. 64% of “don’t know” responses were from respondents at the same program and 5 were from the biospecimen research attribute, indicating the information is difficult for programs to obtain. PI/PA responses varied 36% of the time, of which 70% involved a 1-level difference in response, indicating variation in responses by program role. 2 questions generated inconsistent responses from all 4 pairs, indicating possible further revisions. Average scoring was more accurate and sensitive to incremental program improvements. Conclusions: Broad community input, cognitive interviews, and piloting improved the tool’s clarity. Program leaders are encouraged to use CT AIM with research team members to enhance site infrastructure. CT AIM is useful for quality improvement, benchmarking research performance, progress reporting, and communicating program needs with institutional leaders. NCI Contract No. HHSN261200800001E

A COMPARISON OF THE COST-EFFECTIVENESS OF STROKE CARE PROVIDED IN LONDON AND COPENHAGEN

2000 ◽  
Vol 16 (2) ◽  
pp. 684-695 ◽  
Author(s):  
Richard Grieve ◽  
Vibeke Porsdal ◽  
John Hutton ◽  
Charles Wolfe
Keyword(s):  
Cost Effectiveness ◽  
Purchasing Power Parity ◽  
Average Length ◽  
Cost Effective ◽  
Stroke Care ◽  
Community Health Services ◽  
Case Mix ◽  
Power Parity ◽  
Model Of Care ◽  
London Model

Objectives: This study compared the relative cost-effectiveness of stroke care provided in London and Copenhagen.Methods: Hospitalized stroke patients at centers in London (1995–96) and Copenhagen (1994–95) were included. Each patient's use of hospital and community health services was recorded for 1 year after stroke. Center-specific unit costs were collected and converted into dollars using the Purchasing Power Parity Index. An incremental cost-effectiveness ratio (ICER) was calculated comparing a Copenhagen model of stroke care to a London model, using regression analysis to adjust for case-mix differences.Results: A total of 625 patients (297 in Copenhagen, 328 in London) were included in the analysis. Most patients in London (85%) wereadmitted to general medical wards, with 26% subsequently transferred to a stroke unit. In Copenhagen, 57% of patients were directly admitted to a stroke or neurology unit, with 23% then transferred to a separate rehabilitation hospital. The average length of total hospital stay was 11 days longer in Copenhagen. Patients in Copenhagen were less likely to die than those in London; for patients with cerebral infarction the hazard ratio after case-mix adjustment was 0.53 (95% CI from 0.35 to 0.80). However, a lower proportion of patients with hemorrhagic stroke died in London. The ICER of using the Copenhagen compared with the London model of care ranged from $21,579 to $37,444 per life-year gained for patients with cerebral infarctions.Conclusions: The ICERs of the Copenhagen compared with the London model of care were within a range generally regarded as cost-effective.

Managing a Stroke Unit: An Example from Australia with an Emphasis on Nursing Roles

2007 ◽  
Vol 2 (3) ◽  
pp. 201-207 ◽  
Author(s):  
Louise Weir ◽  
Dominique A. Cadilhac
Keyword(s):  
Patient Outcomes ◽  
Clinical Care ◽  
Stroke Care ◽  
Multidisciplinary Teams ◽  
Special Report ◽  
Royal Melbourne Hospital ◽  
Team Members ◽  
Stroke Team ◽  
Nursing Roles ◽  
Participation In Research

Stroke care units (SCUs), which are co-ordinated by dedicated multidisciplinary teams and geographically located in one area, are currently the most generaliseable form of effective treatment for stroke. Although the evidence for SCUs is compelling, to date there has been limited evidence regarding the contribution of the different clinical team members who assist in producing the better patient outcomes observed in SCUs. In particular, there has been limited exploration of the different nursing roles. The purpose of this special report is to describe how an SCU operates and highlight the contribution of the various nursing roles as part of the multidisciplinary stroke team. The article is based on one of the longest established stroke services in Melbourne, Australia. The characteristics and composition of the Royal Melbourne Hospital stroke service in providing clinical care and management will be highlighted as an example. Further, the nursing roles related to avoiding complications, education for patients and families and other staff in the unit, as well as participation in research and future career development opportunities are discussed.

scholarly journals COVID-19 and Persons with Dementia in Acute Care Settings: How to “EVADE” Challenging Behaviors

2020 ◽  
pp. 1-2
Author(s):  
H. Tan ◽  
A.X. How ◽  
X.X. Wang ◽  
J.E. Lee ◽  
W.S. Lim
Keyword(s):  
At Risk ◽  
Acute Care ◽  
Challenging Behaviors ◽  
Healthcare Systems ◽  
Adverse Outcomes ◽  
Behavioral Issues ◽  
Care Services ◽  
Acute Care Services ◽  
Acute Care Settings ◽  
Care Demands

The double whammy of dementia and coronavirus disease 2019 (COVID-19) has raised huge concerns for healthcare systems which are already struggling to cope with care demands of persons with dementia (PWD) in non-pandemic times (1). PWD who are admitted to acute care services are particularly vulnerable to behavioural changes and adverse outcomes from delirium (2, 3). During the COVID-19 period, ward relocation is frequently encountered due to COVID-19 screening and segregation; this constant changing of environment and care teams puts PWD at risk of behavioural exacerbations. This is aggravated by restrictive visitor policies in hospitals, depriving PWD of the reassuring presence of family members. Not surprisingly, caring for persons with dementia (PWD) with behavioral issues in acute care settings has become extremely challenging.

Quality of care improvements resulting from a model of care that incorporates the primary clerk into the care team.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 122-122
Author(s):  
Jennifer Anne Cox ◽  
Caroline Hamm
Keyword(s):  
Quality Of Care ◽  
Essential Element ◽  
Cost Savings ◽  
Care Team ◽  
Model Of Care ◽  
Team Members ◽  
Team Working ◽  
Team Interactions ◽  
Primary Nurse

122 Background: One common model of care within the oncology outpatient clinic setting is composed of the physician and primary nurse. We propose that the quality of care provided to oncology patients can be improved in this setting by incorporating the primary clerk into the care team, working in the same office space with the physician and nurse. Methods: Three care teams operating under the new model of care were observed during oncology outpatient clinics periodically from February 2016 to May 2016. The primary clerk’s interactions with the other team members were recorded, along with other tasks completed by the clerk that did not require team interactions but impacted quality of care. Data was later complied and organized into four domains that impacted the quality of care provided to patients. Results: The contributions to the care team by the primary clerk include improved clinic flow (e.g., ensuring treatment orders are inputted by the physician), patient convenience (e.g., identifying regularly scheduled blood work that is no longer necessary), patient safety (e.g., identifying patients scheduled for treatment with rituximab that have not had the required Hepatitis B & HIV screening), and hospital flow (e.g., preventing additional workload in the hospital laboratory by identifying when lab work can be combined in already scheduled appointments, and rescheduling clinic visits when results are not yet ready, which translates into time and cost savings to the hospital). Conclusions: As a result of the enhanced quality of care delivered, it is recommended that this model of care be adopted in the place of the traditional model, which lacks the essential element of interaction between the primary clerk and the rest of the care team.

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