1. Stroke Education Q I Initiative– BroMenn Healthcare October 2007

2. 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

3. 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

4. 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

5. Collaborative Practice Team Was Formed

6. 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

7. 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

8. 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

9. 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%

10. Stroke Education

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

12. Stroke Binder

13. Let’s talk about Stroke

14. Progress Stroke education workgroup Development of patient education materials

15. Standardized Documentation

16. Measure Standardized form for documentation More Staff education

17. Ongoing Process Measure Plan Act

18. 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.

19. Almost there Reinforcement to use with TIA patients

20. 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.

21. Breaking the 90 th !! EMR documentation developed

22. Holding the ground Measure Plan Act

23. Questions

24. Contacts Jeff Williams, Neuro Case Manager jwilliams@bromenn.org 309-268-3512