1. Stroke: A process improvement project Niloufar Hadidi, APRN, BC Neuroscience Clinical Nurse Specialist PhD student, University of Minnesota School of Nursing

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

3. Current Situation 2-3 percent of stroke patients currently receive t-PA 2 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 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 hasn’t been used extensively Medical professional are reluctant to use the acute care treatment because of its risk and because it hasn’t been used extensively

4. Primary Stroke Center The extreme sensitivity of neuronal tissues to ischemia mandates that stroke be treated as emergency 2 The extreme sensitivity of neuronal tissues to ischemia mandates that stroke be treated as emergency 2 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 manner 2 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 manner 2 Recent articles regarding PSC Recent articles regarding PSC

5. Gap Analysis 2 Acute stroke team Acute stroke team Written Care Protocols Written Care Protocols Emergency Medical Services Emergency Medical Services Stroke Unit Stroke Unit Neurosurgical Services Neurosurgical Services Neuroimaging/lab Neuroimaging/lab Database Database Educational programs Educational programs

6. DVT Prophylaxis University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

7. AntithromDC: Discharged on Antithrombotics University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

8. Rehab:A Plan for Rehabilitation was Considered University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

9. Afib:Patients with Atrial Fibrillation Receiving Anticoagulation Therapy University of Minnesota Medical Center Time period: Q1 2004 - Q1 2005

10. TPAconsid:Tissue Plasminogen Activator (t-PA) Considered University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

11. TPAadmin:Tissue Plasminogen Activator (t-PA) Administered University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

12. Antithrombotic Medication within 48 Hours of Hospitalization University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

13. Lipids:Lipid Profile University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

14. Dysphagia:Screen for Dysphagia University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

15. Edu:Stroke Education University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

16. Smoke:Smoking Cessation University of Minnesota Medical Center Time Period: Q1 2004 - Q1 2005

17. Change in practice Change in standing orders Change in standing orders Development of patient education Development of patient education Development of stroke website (community outreach) Development of stroke website (community outreach) Development of protocols for patient admission Development of protocols for patient admission All leading to change in practice 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. 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 American Stroke Association web site at www.americanstrokeassociation.org www.americanstrokeassociation.org