Best Practices and Enhancing Your Skills in Stroke Quality Improvement- A Panel Discussion Shandy Bowman, Overland Park Regional Medical Center, Angela Rodecap, Stormont-Vail HealthCare, Angela Hawkins, Saint Luke’s Hospital, Jacki Addington, Research Medical Center, Kathleen Henderson, St. Joseph Medical Center

Shandy Bowman, RN, MSN, CNRN Stroke Coordinator

Overland Park Regional Medical Center 343 licensed beds 1100 employees >550 physicians Average daily census is 136

In 2010, Overland Park Regional Medical Center received our first Primary Stroke Center Certification from both the Joint Commission and the AHA/ASA.

Research Medical Center Full-service, 590 bed acute care hospital, Research Brookside with multiple outpatient services, 100-bed psychiatric hospital Level I Trauma Center 49 Emergency Room Beds 38 bed Med/Surg ICU, 6 th Floor, 4W, 4N 6 Neuro ICU Beds NeuroSurgery Oncall 24/7 Angiography Oncall 24/7 Burn Unit 5

Stroke Program Coordinator 7 years RN, ICU RN – 5 years Neuro-certification, Bi-State Stroke Consortium Co-Chair (Missouri Representative ) Honor’s Society for Nursing – Sigma Theta Tau Community Leader Induction – 2014 APRN/FNP - Dec Jacki Addington, RN, CNRN

TIA Clinic First in the region Dr. Ahmed, Stroke Program Medical Director, presented an abstract in Oct 16, 2012 Brasilia, Brazil at the World Stroke Association on TIA Clinic 7

Stormont-Vail HealthCare Integrated health care system based in Topeka, KS Joint Commission Primary Stroke Center since 2010

Stormont-Vail Regional Health Center is compromised of Cotton O’Neil and PediatricCare Clinics serving a multi-county region. Member of the Health Innovations Network of Kansas (HINK), which is a coalition of hospitals in Kansas that have a common interest to provide quality, cost-effective health care. Licensed beds: 586 acute care hospital Emergency Department Visits: 63,744 Inpatients Admissions: 20,875 Outpatient Visits: 125,728 Clinic visits: 600,158 Total employees: 4,403 Physicians: 200 plus Registered Nurses: 1,196 Licensed Practical Nurses: 323 Patient Care Technicians: 506 Certified Registered Nurses: 275

Stormont-Vail HealthCare is a Primary Stroke Center with discharges around 550 patients per year. Administers tPA to approximately 40 patients per year. Emergency Department providers make decisions regarding administration of tPA. Interdisciplinary stroke team

I have been the Stroke Coordinator at Stormont-Vail HealthCare since 2011 Previously I was a charge nurse in the stroke unit and member of the stroke team I coordinate our monthly meetings, quality improvement plans and review stroke patient charts daily

St. Joseph Medical Center: For-Profit, Acute Care, Community Based Hospital, licensed for 310 beds. Member of Prime Healthcare Services, since February 13, Actually sits on the State Line Road between Kansas City, Missouri and Leawood, Kansas. Recognized as a Magnet Hospital through the ANCC since 2004, re-designated for the 3 rd time this year. St. Joseph Medical Center has been in operation since it was founded in 1874, by the Sisters of St. Joseph of Carondelet. We are the oldest private hospital in KC. 335 Stroke Discharges in 2014.

St. Mary’s Medical Center: For-Profit, Acute Care, Community Based Hospital, licensed for 146 beds. Member of Prime Healthcare Services, since February 13, Located in Blue Springs, Missouri, and sits close to the intersection of Interstate 70 & Highway 7. St. Mary’s has been in Blue Springs for over 30 years, re-locating from downtown Kansas City, Missouri, to provide care to Eastern Jackson County. 147 Stroke Discharges in 2014.

Both hospitals are Joint Commission Certified Primary Stroke Centers. Both hospitals have been designated a Level II Stroke Center by the State of Missouri. Both hospitals have achieved Get With The Guidelines: Gold Plus Status with Target Stroke Honor Roll.

St. Joseph Medical CenterSt. Mary’s Medical Center

Regional Stroke Program Coordinator Member of Bi-State Stroke Consortium MARCER Stroke Support Group TCD Review Crew Stroke Classes Post Discharge Follow Up Champion to enforce Time Parameters for Stroke Care

Stroke Coordinator Role Ensure best evidence practice to all stroke patients Educate staff, physicians, patients and community Coordinate policies and procedures Organize and meet with a multidisciplinary team of patient caregivers Attend and participate with Bi-state Consortium Maintain Stroke Patient Data

Saint Luke’s Health System Part of 11 hospital locally owned not-for-profit Saint Luke’s Health System Saint Luke’s System of Hospitals includes 1 Comprehensive Stroke Center, 2 Primary Stroke Centers, which encompass the 1 Level TCD Stroke Center, 1 Level II TCD Stroke Center, and 3 Level III TCD Stroke Centers

Saint Luke’s Hospital-Plaza Campus Licensed 602 bed tertiary/quaternary care teaching hospital Level 1 Stroke Center Designation Level 1 Trauma Center Designation Advanced Comprehensive Stroke Center Received 3rd Magnet Nursing designation in spring 2014

All in one 8 story tower neuroscience facility specifically designed to integrate care and provide a continuum of services that result in improved neuroscience outcomes.

Angela M. Hawkins, BSN, RN, CCRN, CNRN, SCRN System Stroke Program Manager of Saint Luke’s Marion Bloch Neuroscience Institute & Saint Luke’s Health System. Helped the team in obtaining Comprehensive Stroke Certification Lead the team to obtain its first ever Level 1 Time Critical Designation for Stroke Aided in System hospitals obtained their TCD designations with ongoing compliance Over 15 years of Neuroscience, ICU, ER, IR and Cath lab experience and is currently in her doctorate to help promote advances in stroke and endovascular translational and outcomes research.

Panel Discussion

Data Quality measures or metrics apply to processes and aspects of care that are strongly supported by science. Each metric needs to be analyzed and evaluated: - Where does the information come from? - What is done with it? - Who is responsible for what? - How is it coordinated?

Quality Monitoring Collaborative discussions with physicians and other healthcare groups Standing Stroke Care Committee Loop closure Integration with Hospital PI process

STRATEGIES TO MEET CORE MEASURES Embed the measures in your documentation tools (e.g. teaching handouts) Incorporate into Order sets (e.g. EMR use of hard stops and drop down options) Core Measure checklists or concurrent chart review for validation prior to discharge Incorporate measures in staff/MD training Ongoing reporting through PI structure Other?

Target: Stroke Best Practices 1.EMS pre-notification 2.Stroke toolkit 3.Rapid triage & Stroke Team notification 4.Single call activation 5.Direct transfer to CT 6.Rapid brain imaging 7.Rapid lab testing (POC INR) 8.Pre-mix TPA 9.Rapid administration of TPA 10.Team-based approach 11.Prompt data feedback

A friendly piece of advice from our Panelists to new stroke coordinators…….. Questions?