Stroke Education Q I Initiative– BroMenn Healthcare October 2007

BroMenn Healthcare Normal, 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

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

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

Collaborative Practice Team Was Formed

Practice Team Establishes the program’s 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

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

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

Benchmarking MeasureQ3 ‘04 Q1 ’07 (January)Target Illinois Capture DVT Prophylaxis64%100% 75% Antithrombotics at Discharge89%100% 97% Anticoagulation for A Fib100% 93% TPA Considered67%100% 45% Antithrombotics w/in 48 Hrs89%94%100%91% Lipid Profile33%78%90%60% Screen for Dysphagia47%56%100%47% Stroke Education14%92%90%64% Smoking Cessation17%100%90%84% Plan for Rehab70%88%90%88%

Stroke Education

Work Group Meeting Stroke Units Marketing; Community Wellness Leadership (QRM, Clin. ED) Collaborative Culture

Stroke Binder

Let’s talk about Stroke

Progress Stroke education workgroup Development of patient education materials

Standardized Documentation

Measure Standardized form for documentation More Staff education

Ongoing Process Measure Plan Act

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.

Almost there Reinforcement to use with TIA patients

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.

Breaking the 90 th !! EMR documentation developed

Holding the ground Measure Plan Act

Questions

Contacts Jeff Williams, Neuro Case Manager