Stroke Education Q I Initiative

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Stroke Education Q I Initiative BroMenn
Healthcare

• October 2007

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BroMenn HealthcareNormal, Illinois

• BroMenn Regional Medical Center (BRMC)
• 224 bed, full-service, teaching hospital
• Level II trauma center with regional referral
• Dedicated neuroscience unit
• Inpatient rehabilitation
• Eureka Hospital (ECH)
• 34 bed, critical access hospital
• Home Care Hospice

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Decision to Pursue Stroke Designation at BRMC

• To build on existing program strengths
• Neuro, neurosurgical neuro-residency programs
• Patient volume sufficient to support a dedicated
  program
• 200 strokes admitted annually
• 100 TIAs admitted annually

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Designation Objectives

• Promote a culture of interdisciplinary,
  patient-focused approach to stroke care across
  the care continuum
• Promote evidence-based practice
• Maximize patient care outcomes
• Continuous quality improvement

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Collaborative Practice Team Was Formed
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Practice Team

• Establishes the programs care delivery model,
  goals improvement priorities
• Researches and implements best practices
• Coordinates educational efforts
• Monitors quality measure performance
• Develops performance improvement plans
• Includes interdisciplinary hospital, medical
  staff and community representation
• Meets 4-6 times per year

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Care Delivery Model Was Established
Model developed from guidelines published by AHA,
ASA and the Mayo Clinic. Addresses screening
performed in the community as well as the
hospital Includes diagnosis and care of ischemic
and hemorrhagic strokes, and TIAs
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The Model Encompasses

• FAST Screening
• EMS protocols and education
• Clinical practice guidelines to direct patient
  care
• Protocols for rapid diagnosis, BP management,
  thrombolysis, education and prevention of
  complications
• Monitoring for early detection and response to
  problems
• Early establishment of rehabilitation plan

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Benchmarking
Measure Q3 04 Q1 07 (January) Target Illinois Capture
DVT Prophylaxis 64 100 100 75
Antithrombotics at Discharge 89 100 100 97
Anticoagulation for A Fib 100 100 100 93
TPA Considered 67 100 100 45
Antithrombotics w/in 48 Hrs 89 94 100 91
Lipid Profile 33 78 90 60
Screen for Dysphagia 47 56 100 47
Stroke Education 14 92 90 64
Smoking Cessation 17 100 90 84
Plan for Rehab 70 88 90 88
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Stroke Education
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Work Group Meeting
Stroke Units
Collaborative Culture
Marketing Community Wellness
Leadership (QRM, Clin. ED)
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Stroke Binder
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Lets talk about Stroke
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Progress
Stroke education workgroup
Development of patient education materials
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Standardized Documentation
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Measure
More Staff education
Standardized form for documentation
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Ongoing Process
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CVA - TIA

• We do not use a separate CareMap for TIA
  patients.
• CVA patients were over the 90 mark, but TIA
  patients were not receiving the education.

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Almost there
Reinforcement to use with TIA patients
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Meditech Documentation

• Over the course of the last year on-line
  documentation had come full swing.
• We knew nurses were educating and the supply of
  notebooks correlated.
• Documentation needed to occur in the electronic
  realm.

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Breaking the 90th !!
EMR documentation developed
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Holding the ground
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Questions
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Contacts

• Jeff Williams, Neuro Case Manager
• jwilliams_at_bromenn.org
• 309-268-3512