1. Time Use Data to Improve Stroke Care Terri Hamm RN Stroke Team Coordinator Mercy Medical Center, Des Moines

2. Why Data? Quite simply, data drives careQuite simply, data drives care You can’t know where you are going unless you know where you have beenYou can’t know where you are going unless you know where you have been Without process evaluation, there is no opportunity for process improvementWithout process evaluation, there is no opportunity for process improvement Best practices require constant data capture and analysisBest practices require constant data capture and analysis

3. Stroke Data-What matters most? The Joint Commission currently has 8 performance measures for acute stroke;The Joint Commission currently has 8 performance measures for acute stroke; VTE prophylaxisVTE prophylaxis Anti-Thrombotic Therapy by Hospital Day 2Anti-Thrombotic Therapy by Hospital Day 2 Discharged on Anti-thrombotic TherapyDischarged on Anti-thrombotic Therapy Discharged on Cholesterol Reducing MedicationDischarged on Cholesterol Reducing Medication Stroke EducationStroke Education Assessed for RehabilitationAssessed for Rehabilitation Pt’s with A-Fib receiving anti-coagulation therapyPt’s with A-Fib receiving anti-coagulation therapy Thrombolytic Therapy AdministeredThrombolytic Therapy Administered

4. EMS Role in Documentation EMS is the first link in the chain of survivalEMS is the first link in the chain of survival Hand-offs to ED staff/stroke team essentialHand-offs to ED staff/stroke team essential Clear and concise information assists in determination of patient treatment optionsClear and concise information assists in determination of patient treatment options So what do we need from you???So what do we need from you???

5. Hand-Offs Give a heads-up to the ED that you are transporting a possible stroke in progressGive a heads-up to the ED that you are transporting a possible stroke in progress Clear and concise description of symptomsClear and concise description of symptoms Time of onset of symptoms if possible; if not, we MUST have time last known wellTime of onset of symptoms if possible; if not, we MUST have time last known well Glucose levelGlucose level Any medications or pertinent history that would preclude the use of t-PA or require additional lab tests particularly anti-coagulation useAny medications or pertinent history that would preclude the use of t-PA or require additional lab tests particularly anti-coagulation use

6. Time is Critical Document time on scene; what delays occur that a process change could assist withDocument time on scene; what delays occur that a process change could assist with Document arrival to ED door; our clock for treatment starts when you hit our doorDocument arrival to ED door; our clock for treatment starts when you hit our door Document any meds/IV fluids/other treatments initiated en-routeDocument any meds/IV fluids/other treatments initiated en-route Clear documentation of blood pressure and heart rate; assists in triage decisionsClear documentation of blood pressure and heart rate; assists in triage decisions

7. Treatment Opportunities IV t-PA is the first line choice of treatment for patients presenting within a three hour window from symptom onsetIV t-PA is the first line choice of treatment for patients presenting within a three hour window from symptom onset Extended t-PA window to 4.5 hours for subset of patients that qualifyExtended t-PA window to 4.5 hours for subset of patients that qualify Opportunity for Intra-Arterial t-PA or clot extraction within 6 hours; may extend that time to 12 hours if stroke is posterior circulationOpportunity for Intra-Arterial t-PA or clot extraction within 6 hours; may extend that time to 12 hours if stroke is posterior circulation Research opportunities may extend window to 9 hours in qualified subjectResearch opportunities may extend window to 9 hours in qualified subject

8. EMS Guidelines If within 30 minutes of a certified stroke center patient should be routed thereIf within 30 minutes of a certified stroke center patient should be routed there All stroke centers do not have the same capacity for treatment of acute ischemic stroke and/or hemorrhagic strokeAll stroke centers do not have the same capacity for treatment of acute ischemic stroke and/or hemorrhagic stroke Know the capabilities of the hospitals you transport your patients toKnow the capabilities of the hospitals you transport your patients to Document clearly if a patient or family refuse transport to stroke centerDocument clearly if a patient or family refuse transport to stroke center

9. The Wave of the Future Instead of door to needle times we will soon be capturing times related to point of first medical contact; for many patients that is EMS; the clock starts with you; we will soon be required to capture door to CT scan in our data setsInstead of door to needle times we will soon be capturing times related to point of first medical contact; for many patients that is EMS; the clock starts with you; we will soon be required to capture door to CT scan in our data sets Time is brain; we will be pushed to continue searching for process improvement opportunities that will shorten our times to treatTime is brain; we will be pushed to continue searching for process improvement opportunities that will shorten our times to treat How will we know if we are successful?How will we know if we are successful?

10. DATA!!!!!! The documentation you do on your run sheets is important and often times the only source of data we have in determining a care pathThe documentation you do on your run sheets is important and often times the only source of data we have in determining a care path We look at your run sheets and they matter!We look at your run sheets and they matter! The more data we have the better the quality of our assessments become and the more opportunities there are for process improvementThe more data we have the better the quality of our assessments become and the more opportunities there are for process improvement

11. In Conclusion What you do in the field mattersWhat you do in the field matters How you document mattersHow you document matters You are the first link in the chain of survivalYou are the first link in the chain of survival In other words, it all starts with you!In other words, it all starts with you! Thank you for your dedication to our patients and your communitiesThank you for your dedication to our patients and your communities

12. Questions?????? Have a great day! Have a great day!