NEUROSCIENCE SERVICE LINE TEAM STROKE Core Team Leslie

NEUROSCIENCE SERVICE LINE TEAM STROKE Core Team: Leslie Barna, RN, MSN Jose Biller, MD Barbara Buturusis, RN, MSN Linda Chadwick, RN, BSN Rima Dafer, MD Ann Hahn Mary Healey, RN, BS Lisa Millsap, Pharm. D, ACNP Michael Schneck, MD Staff of 2 NE, 2 W and Telemetry Admitting Center for Clinical Effectiveness Center for Home Care & Hospice Clinical Neurodiagnostic Laboratory Education and Support Services Emergency Department Human Resources/Organizational Development Interventional Radiology Laboratory Marketing Medical Records Neurosurgery Nutrition Pastoral Care Primary Care Psychiatry Rehabilitation Services Social Work

NEUROSCIENCE SERVICE LINE PLAN TEAM STROKE ØProject Aim Statement § To standardize and improve care for acute stroke and transient ischemic attack (TIA) patients from the time the patient has stroke symptoms through the rehabilitation phase. § To achieve JCAHO Disease Specific certification for the Stroke program by demonstrating compliance with standards and Brain Attack Coalition guidelines for stroke care.

NEUROSCIENCE SERVICE LINE How the Stroke Program Monitors and Improves Quality TEAM STROKE Ø “Get with the Guidelines” On - Line Patient Management Tool Ø Using Plan, Do, Study, Act pursue 100% compliance we with: 1. 2. 3. 4. 5. 6. 7. JCAHO 1 DVT Prophylaxis JCAHO 2 Discharge on Anti-Thrombotics JCAHO 3 A. Fib. Patients Discharged on Anticoagulants JCAHO 4 A rt - PA Considered and Documented JCAHO 4 B rt - PA Administered – when appropriate JCAHO Disease Specific Standards Stroke Program Guidelines

NEUROSCIENCE SERVICE LINE DO – Solutions Implemented TEAM STROKE Ø Implemented evidence based clinical guidelines and standard orders for stroke care Ø Initiated a Stroke Immediate Response Team (pager 14911) Ø Initiated Stroke patient database and analyzed results Ø Standardized Neurology H & P and progress note Ø Daily multidisciplinary rounds Ø 10 Acute or Preventive Stroke Clinical Trials

NEUROSCIENCE SERVICE LINE DO – Design & Implement Team Structure TEAM STROKE Pre ED and ED Team Begins in the Community; Ends with ED discharge • Stroke Education Program (e-learning) • Rapid Response - Lab Analysis • Rapid Response - Radiology CT • Code Red -Elevated Triage Level • Implemented Clinical Trials Rehab Team Begins with Hospital admission; Ends with Rehab discharge • Daily Multidisciplinary Rounds • Rehab Level of Care criteria • Weekend therapy sessions • Neuro Therapy Team - consistency of therapists Acute Team Begins with Hospital admission; Ends with Hospital dis • Opened Acute Stroke Unit • Global nursing education • Standardized order sets • Stroke Guidelines Stroke Prevention Team Coordination of professional and community edu • Stroke Month Activities: Staff & management education, Stroke Screening and Risk Factor Assessment • Smoking Cessation Classes • Stroke Support Group • Power to End Stroke in African American Community (May 06) • Community Television Ad (Spring 06) • Web Site Development • Patient Education Standardization

NEUROSCIENCE SERVICE LINE STUDY TEAM STROKE Patients with ischemic stroke (non-ambulatory) received DVT prophylaxis by Day 2 Since May 2005, the team achieved 100% January 2005 - December 2005 160 140 120 Percent UCL = 117. 82 100 Mean = 94. 95 80 LCL = 72. 08 60 5 /0 12 5 /0 11 5 /0 10 5 /0 09 5 /0 /0 07 Month 08 5 5 /0 06 5 /0 05 5 /0 04 5 /0 03 5 /0 02 /0 5 40 01 1.

NEUROSCIENCE SERVICE LINE STUDY TEAM STROKE 2. 100% of patients with acute ischemic stroke or TIA received antithrombotic therapy within 48 hours of admission 3. 100% of patients with acute ischemic stroke or TIA and atrial fib. were discharged on anticoagulants January 2005 - December 2005 100. 010 100. 005 Percent 100. 010 100. 000 Month 5 /0 12 5 /0 11 5 /0 10 5 /0 09 5 /0 /0 07 Month 08 5 5 /0 06 5 /0 05 5 /0 04 5 /0 03 5 /0 02 5 /0 01 5 /0 10 5 /0 09 5 /0 07 5 /0 06 5 /0 04 /0 03 /0 02 /0 01 5 99. 990 5 99. 995

NEUROSCIENCE SERVICE LINE STUDY TEAM STROKE 4. Patients with ischemic stroke who present to the hospital within 3 hours of symptom onset are: a. Considered for rt-PA b. Receive rt-PA if indicated Team working to improve documentation Team working on meeting criteria in all clinical settings January 2005 - December 2005 t 180 200 160 UCL = 159. 16 140 150 Percent UCL = 139. 19 120 100 Mean = 88. 89 80 Mean = 68. 57 50 60 40 Month 5 /0 12 5 /0 11 5 /0 07 5 /0 12 5 /0 11 5 /0 10 5 /0 LCL = 18. 62 05 Month 09 5 /0 07 5 /0 06 5 /0 05 5 /0 04 5 /0 01 20 06 LCL = 0. 00 0

NEUROSCIENCE SERVICE LINE ACT – Next Steps TEAM STROKE Ø Monitor compliance with JCAHO standards and quality indicators and continue to improve documentation Ø Customize Stroke patient education tool Ø NIH Stroke Scale Certification Ø Ongoing staff education Ø Continue and expand community outreach targeting high risk populations Ø Promote consistent utilization of stroke guidelines and order sets for off service patients Ø Increase the number of participants in clinical trials Ø Submit JCAHO intra-cycle report including measures of success (January 2007)

NEUROSCIENCE SERVICE LINE ACCOMPLISHMENTS TEAM STROKE Achieved the first JCAHO Disease Specific Certification at LUHS Ø Standardized stroke care and improved quality Ø Initiated program of clinical trials Ø Established engaged, interdisciplinary cross-continuum teams Ø Secured capital funding and initiated Acute Stroke Unit Ø Received LUHS Leadership Award