1. Stroke Coordinator: ROI
Author:
Debbie Roper, RN, MSN (d.r. Stroke)
Vice President of Roper Resources, Inc.

2. Debbie Roper is a speaker for:
Disclosure
Debbie Roper is a speaker for:
Genentech – Activase
Chiesi - Nicardipine
Debbie has no actual or potential conflict of interest in relation to this presentation.

3. Stroke Consulting Services
Stroke Program Development Course
(Six Month Recipe)
Mock Stroke Surveys
Certification Consulting Services
Red Gate Inn, McKinney, TX
Redgateinn.com

4. Objectives
Discuss the role of stroke coordinator on increasing in- patient stroke volumes
Discuss impact of decreasing length of stay on ROI
Understand the value of increasing Activase treatment rates
Rationalize the direct cost incurred for the role of a full time stroke coordinator.

5. Cost increase predictions from 2012-2030
Total direct annual stroke related medical costs expected to increase from $71.55 billion to $ billion
Real indirect annual costs projected to rise from $33.65 billion to $56.54 billion
Overall annual costs of stroke projected to increase to $ billion by 2030 (129% increase)
Stroke 2013; 44:

6. Aging population = Increase in prevalence of stroke
Additional 3.4 million people with stroke in 2030
By 2030 nearly 4% of the US population is projected to have had a stroke
Stroke 2013; 44:

7. Revised & Updated Recommendations for the Establishment of PSCs
A Summary Statement From the Brain Attack Coalition
Less disability associated with use of rt-PA
Use of rt-PA increased in PSCs
Less disability = less lifetime cost
Stroke units (Class I, Level A)
17-28% reduction in death
7% increase in being able to live at home
8% reduction in length of stay
19% increase in good outcomes
Stroke. 2011;(42):

8. Stroke Coordinator Role
Commander
Chief
Educator
Motivator
Data Abstractor
Data Analyzer
Speaker
Organizer
Facilitator
Detective
Data Analyst

9. Stroke Coordinator Qualifications
Registered Nurse Neurology Experience
Critical Care Experience (ED/ICU) Public Speaking Experience
Performance Improvement Experience Educating Experience
BCLS + ACLS (per job description) NIHSS
8 hrs stroke CNE annually

10. What does a SUCCESSFUL Stroke Coordinator look Like?
Achieved/Maintained Stroke Certification?
No Recommendations for improvement on stroke survey?
Longevity in stroke coordinator position?
Stroke Core Measures are 100%
Prove You are Valuable
to your organization

11. Prove ROI with data Four Elements of a Successful Stroke Coordinator
Stroke Volumes
Stroke Treatments
Stroke Outcomes
Stroke Length of Stays
Prove ROI with data

12. Increase Stroke Volume

13. What does success look like? Volume of In-Patient Strokes
Yahoo! a steady increase in stroke volume
What About?
Mode of Arrival (EMS vs Pvt Vehicle)
Arrival within time window for stroke treatments
Inter-facility Transfers
Denials – Potential leakage to the competition
Must be measurable

14. Stroke Patient Mode of Arrival
EMS Volumes by Provider ?
Total
Percent
Ambulance
Automobile

15. What does Success Look Like? Main EMS Providers
EMS volume increases
EMS is a participant on stroke committee
EMS stroke protocols are reviewed annually
EMS stroke protocols follow current CPGs
EMS run sheets are provided on every patient
Care provided by EMS is assessed to ensure
protocol adherence
EMS Feedback is provided by stroke center
EMS attends stroke survey
Main EMS Providers
EMS 1
EMS 2
EMS 3
EMS 4

16. Time of Arrival from LKN
Acute vs Subacute
What does Success Look Like?
Community education events increase (> 2/yr)
Largest Employer
Zip code origin
Acute stroke volume increases
< hours from LKN
hours from LKN
< 6/8 hours from LKN

17. Increase Stroke Treatments

18. Increase Stroke Treatments
What does Success Look Like?
ED Physicians find a reason to treat with IV Activase
Every acute stroke patient is screened
for stroke treatments
IV/IA Activase
Thrombectomy Devices
Clipping/Coiling
Carotid Stents
Intracranial Stents
Percent of all Ischemic stroke patients who receive IV Activase increases (not just acute)

19. Are Your ED Physicians Finding a Reason to TREAT or NOT TO TREAT?
What does Success Look Like?
No missed opportunities
ED Physicians discuss their concerns r/t Activase
ED Physicians prescribe Activase without Neurologist
Individual ED Physician Report Cards
Increase number of patients receiving IV Activase
Created by Genesis Lewis RN, BSN
Dallas, Texas

20. What does Success Look Like?
Are You Screening Every Acute Stroke Patient for Eligibility for Endovascular Treatments?
What does Success Look Like?
Transfer agreement with CSC
CSC provides all PSC and ASR facilities with screening criteria
LKN is < 6hrs
NIHSS > 8/10 or higher
NIHSS < 4 with aphasia
CTA = large vessel infarct
Every Activase patient is screened for Thrombectomy prior to admission to ICU
All ED Practitioners are knowledgeable about CSC screening criteria

21. Collaborate with EMS – PSC vs CSC – for Stroke Treatments
What does Success Look Like?
State EMS transfer protocols - CSC vs PSC
EMS screen from scene for PSC vs CSC
EMS participate in IRB studies to validate screening

22. Improve Stroke Outcomes

23. How Do You Measures Stroke Outcomes?
What does Success Look Like?
Patient Disposition – increase of patient discharged to home and/or rehab
Compare Initial and Discharge NIHSS – decrease in NIHSS or return to baseline at discharge
mRS at 90 days – able to perform activities of daily living
No Stroke readmissions within 30 days

24. Don’t forget the financial impact of improved outcomes
Calculate complication rates (pneumonia 3%)
Calculate cost/case of complication rates
Pneumonia, DVT, PE (Increase of $33,155)
Effective dysphagia screening at bedside can reduce aspiration pneumonia by 50% (Hinchey, et al. Stroke 2005;36)
3% of 340= 10.2 patients with pneumonia ($338,181)
50% reduction = $169,090 in “cost avoidance”

25. Decrease Length of Stay

26. The DRG system is in place to incentivize hospital efficiency
Strategies for decreasing cost revolve largely around the formation of stroke units
Savings of ~$55 million per 1000 patients
Stroke 2012; 43:

27. Decrease Length of Stay (Ischemic, Hemorrhagic, TIA)
What does Success Look Like?
Ischemic stroke LOS =
Hemorrhagic stroke LOS
TIA LOS

28. A Successful Stroke Coordinator’s ROI Using Four Elements
Stroke Volumes Increase Year over Year
Stroke Treatments Increase
Stroke Outcomes Improve
Stroke Length of Stays Decrease

29. Questions