Stroke: A process improvement project

1
Stroke A process improvement project

• Niloufar Hadidi, APRN, BC
• Neuroscience Clinical Nurse Specialist
• PhD student, University of Minnesota
• School of Nursing

2
Statistics

• 3rd leading cause of death in the United States 1
• 1st leading cause of long term disability 1
• 700,000 Americans 1
• Leading cause of serious long term disability 1
• Cost 57.9 billion per year 1

3
Current Situation

• 2-3 percent of stroke patients currently receive
  t-PA 2
• Nationally, only 26 of the population can name
  the most commonly recognized warning signs of
  stroke
• Medical professional are reluctant to use the
  acute care treatment because of its risk and
  because it hasnt been used extensively

4
Primary Stroke Center

• The extreme sensitivity of neuronal tissues to
  ischemia mandates that stroke be treated as
  emergency2
• Primary stroke center (PSC) was specifically
  assigned by Brain Attack Coalition for hospitals
  that develop an infrastructure necessary to care
  for stroke patients in a timely manner2
• Recent articles regarding PSC

5
Gap Analysis 2

• Acute stroke team
• Written Care Protocols
• Emergency Medical Services
• Stroke Unit
• Neurosurgical Services
• Neuroimaging/lab
• Database
• Educational programs

6
DVT ProphylaxisUniversity of Minnesota Medical
CenterTime Period Q1 2004 - Q1 2005
7
AntithromDC Discharged on AntithromboticsUnivers
ity of Minnesota Medical CenterTime Period Q1
2004 - Q1 2005
8
RehabA Plan for Rehabilitation was
ConsideredUniversity of Minnesota Medical
CenterTime Period Q1 2004 - Q1 2005
9
AfibPatients with Atrial Fibrillation Receiving
Anticoagulation TherapyUniversity of Minnesota
Medical CenterTime period Q1 2004 - Q1 2005
10
TPAconsidTissue Plasminogen Activator (t-PA)
ConsideredUniversity of Minnesota Medical
CenterTime Period Q1 2004 - Q1 2005
11
TPAadminTissue Plasminogen Activator (t-PA)
AdministeredUniversity of Minnesota Medical
CenterTime Period Q1 2004 - Q1 2005
12
Antithrombotic Medication within 48 Hours of
HospitalizationUniversity of Minnesota Medical
CenterTime Period Q1 2004 - Q1 2005
13
LipidsLipid ProfileUniversity of Minnesota
Medical CenterTime Period Q1 2004 - Q1 2005
14
DysphagiaScreen for DysphagiaUniversity of
Minnesota Medical CenterTime Period Q1 2004 -
Q1 2005
15
EduStroke EducationUniversity of Minnesota
Medical CenterTime Period Q1 2004 - Q1 2005
16
SmokeSmoking CessationUniversity of Minnesota
Medical CenterTime Period Q1 2004 - Q1 2005
17
Change in practice

• Change in standing orders
• Development of patient education
• Development of stroke website (community
  outreach)
• Development of protocols for patient admission
• All leading to change in practice

18
References

• Alberts et al (2000). Recommendations for the
  establishment of primary stroke centers. JAMA
  283(23), 3102-3109.
• American Stroke Association web site at
  www.americanstrokeassociation.org