target: stroke - american heart associationprivate/@wcm/@hcm/... · target: stroke the team-based...

Target: STROKE

The Team-Based Approached

November 19, 2013 Tuesday

1300 – 1400

Thank you for joining today’s webinar, the presentation will begin shortly.

11/19/2013 ©2010, American Heart Association 2

A special thank you to Cornerstone Therapeutics Inc., for

sponsoring this educational event

Kathleen Burger, DO Mary Cres Rodrigazo, BSN, RN, SCRN Barbara Neiswander, MSN, RN, CEN

Stroke Program Director Stroke Program Coordinator Clinical Supervisor

The George Washington The George Washington Emergency Department

University Hospital University Hospital The George Washington

Washington, DC Washington, DC University Hospital

Washington, DC

Speakers for Today’s Program:


• Describe the process involved in a team-based approach to

stroke care.

• Review protocols that lead to efficient and rapid treatment of

acute stroke patients

• Discuss the importance of a multidisciplinary approach to

stroke care and performance improvement

Objectives:


STROKE STATISTICS

Affects 795,000 persons a year

On average, stroke occurs

every 40 seconds

Every 4 minutes, someone dies

of stroke

4th Leading cause of death

Leading cause of Disability

Cost $73 billion per year

11/19/2013 5

Global Statistics

15 millions strokes yearly

• 5 millions deaths

• 5 million with disability

DEMOGRAPHICS

11/19/2013 6

371 beds

18,372 Inpatient Admissions

108,710 Outpatient Visits

Emergency Department

(Level I Trauma Center)

74,056 Patient Visits.

The George Washington University Hospital

National Capital Area

The George Washington University Medical Center

Acute Stroke Unit

Emergency

Radiology

Laboratory

Nursing

Stroke Coordinator

Department of Neurology

American Heart Association

Interventional

E

M

S

Stroke Team

CORE

Stroke Neurologist

Stroke Coordinator

Neurology Residents

Stroke Nurses

MULTIDISCIPINARY

• Stroke and general Neurologists • Attending and Residents

• Stroke Coordinator

• Stroke Nurses

• ICU

• Emergency Department

• Neurosurgery

• Neuroradiology

• Interventional Neuroradiology

• Rehabilitation Team (PT OT ST)

• Quality team and Data Analysts

• Administration

• Educators

COMPREHENSIVE To be determined

ER Stroke Protocol

Brain Attack Policy

Neurological

Examination

ER order set

oIV-monitor-vitals-

glucose

oNIHSS

oLabs

oBrain imaging

Initiate Brain Attack system

Brain Attack Protocol

Stroke tPA protocol

Multidisciplinary Stroke Meeting

• Attendees: Stroke Neurologist – Stroke Coordinator –

Emergency Department - Neuroradiology – Neurosurgery –

Rehabilitation team – Quality (Data abstractors)

• Review data

• Define refine and maintain the system - Checks and Balances

• Opportunities for improvement

• Maximize strengths

• Improve weaknesses


0

5

10

15

20

25

30

35

40

2009 2010 2011 2012 2013 YTD

IV-tPA Outcome

Patients Symptomatic ICH

Achievements:

• Advanced Primary Stroke Center

with Joint Commission Certification

2007- Present

• Gold Plus Achievement Award by

The American Heart Association

2010, 2011, 2012, 2013

• Target Stroke Honor Award by The

American Heart Association 2011-

2012 and 2012-2013


GOALS

• Maintain effective protocols

• Improve treatment times

• Stroke Unit Expansion

• GW Transfer -One Call

• Comprehensive Stroke Center

The Road To Target Stroke


• Lean Six Sigma

• Brain Attack Responders

• Comprehensive Stroke Education

• Stroke Data Measures

• Stroke Collaborative Group

• Target Stroke

Process:


LEAN Six Sigma

• Neurology

• Emergency

Department

• Laboratory

• Radiology

• Quality

• Identify our goal

• Review and understand the

process

• Remove steps by creating

Flow Chart

• Develop strategies

• Implementation though

process change

Brain Attack Responders: • Neurology Residents


• Charge Nurses ASU

• Clinical Supervisor

Scope of Practice

– Respond to all BA in house and

the ED

– Arrived within 10 minutes

– Support neurologist and nurses

mixing tPA

•


NIH Stroke Scale Certification

Mandatory Stroke Class

Stroke Healthstream Modules

• Emergency Room Nurses

• Intensive Care Unit

• Acute Stroke Unit

• Radiology Technicians

Comprehensive Stroke Education:



0

10

20

30

40

50

60

70

80

90

Min

ute

s

Average Door to tPA (tPA Pts)


0

5

10

15

20

25

30

35

40

Min

ute

s

Average Door to CT (tPA Pts)


32

33

34

35

36

37

38

39

40

41

42

Min

ute

s

Average Door to Lab Result (tPA Pts)

Stroke Census

The George Washington University Hospital

371

PTS

405

PTS

400

PTS

467 PTS 439 PTS 365 PTS 371

PTS

405

PTS

400

PTS 467 PTS 439 PTS 405 PTS

• Share resources and best practices

• Stroke improvement process

• Stoke education and training

• Community City wide stroke

outreach

o Stroke Screening

o Blood pressure Screening

o Stroke Education

Joining Collaborative Group


Target: Stroke Best Practices EMS Pre – Notification

Stroke Tools

Rapid Triage Protocol &

Stroke Team

Single Call Activation

System

Transfer Directly to CT

Rapid Acquisition &

Interpretation of Brain

Imaging

Rapid Lab Testing

Mix tPA ahead of time

Rapid access of IV tPA

Team-based approach

Prompt data Feedback 11/19/2013 ©2010, American Heart Association 27

Target Stroke:

Best Practices


• EMS Arrival

• Brain Attack Page

• Direct bedding

• Quick Registration

• Immediate stroke

protocol initiated

Stroke Arrival to the Emergency Department:


Rapid Triage of Ambulatory Patients

11/19/2013 30

Brain Attack Announcement

overhead or pager

The following are being notified:

• Neurology Attending

• Neurology Residents


• House Operation Supervisor

• Brain Attack Responder

Single Call Activation System:


Stroke Tools

• GW Home Page

Recognition

• Stroke algorithm

developed

• Stroke protocols

• Brain Attack order set


STROKE Care in the ED

• Designated Stroke Area in

the ED

• ED specific Critical Care

room for Stroke patients

• Reference Stroke Board

• t-PA Tackle Box

• Pump for medication

administration

Rapid Laboratory Testing:

• Laboratory technician

– Direct Hand off

– Blue Card

– Call back to the ED with

lab results

– I -STAT for Point of Care

Testing

Radiology • CT radiology technician

• Priority Patient

• Radiologist for immediate reading

• Post scan weight

• 24/7 Availability

• CT Next Door

• Door to Results 45 minutes

Medication

Stroke Documentation

11/19/2013 37

• Immediate feedback to all

individuals involved in stroke

care of the patient including

EMS

• Address delays based of results of

each case to devise strategies

• Set targets and monitor progress

closely on a case to case basis.

Feedback Form:


Questions ?


American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease

and Stroke Statistics – 2012 Update: A Report From the Americal Heart Association. Circulation.

2012;125:e2-e220; originally published online December 15, 2011; doi:

10.1161/CIR.0b013e31823ac046

American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral

Vascular Disease, and Council on Clinical Cardiology. Guidelines for the Early Management of

Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American

Heart Association/American Stroke Association. Stroke. 2013;44:870-947; originally published

online January 31, 2013; doi: 10.1161/STR.0b013e318284056a

REFERENCES


target: stroke - american heart associationprivate/@wcm/@hcm/... · target: stroke the team-based...

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