Data Advances Improvements in Stroke Care Delivery, Reducing Mortality

Thibodaux Regional Health System had implemented evidence-based stroke care interventions in its emergency department. However, the organization was not meeting its established goals for early identification and treatment. With strong leadership support and the help of analytics, the organization’s stroke care transformation team was able to identify opportunities for improvement, culminating in improved care delivery through facility-wide automated alerts and a reduction in the need to transfer patients to other facilities for treatment.

FOR PATIENTS EXPERIENCING A STROKE, TIMELY CARE IS CRITICAL

对美国人来说，中风是导致严重长期残疾的主要原因，是导致死亡的第五大原因，每年的医疗成本高达340亿美元。对于中风患者来说，早期识别和治疗可以改善中风的预后。^1,2

Thibodaux Regional Health System, a nationally recognized hospital for excellence in patient care, is committed to providing high-quality, comprehensive services. Leadership turned their attention to the stroke population, hoping to identify opportunities to improve early recognition and treatment.

INCOMPLETE DATA SLOWS IMPROVEMENT OF STROKE OUTCOMES

Despite having implemented evidence-based stroke care in the ED, Thibodaux Regional was not meeting organizational goals for early stroke identification and timely intervention. The hospital lacked a standardized process for early identification of patients with a stroke. When stroke was identified, there was not a standard mechanism to notify providers, which delayed diagnostic testing and treatment. Additionally, when it came to judging performance on timely interventions, Thibodaux Regional lacked actionable data. It needed a comprehensive data-driven approach for early notification of possible stroke, including improved door-to-evaluation and treatment goals to reduce mortality, minimize transfers, and provide quality patient care.

Another problem was the lack of complete data on certain patients. Thibodaux Regional lacked continuous neurology coverage, which necessitated a higher-than-desired volume of patients being transferred to other acute-care facilities for treatment. The transfers represented lost opportunities to provide care across the continuum and impacted patient satisfaction.

CARE TRANSFORMATION TEAM DRIVES DATA-DRIVEN IMPROVEMENTS

With the support of the chief executive officer and senior executive leadership, Thibodaux Regional established a stroke care transformation team—an interdisciplinary team including the medical director, vice-president of nursing, ED director, intensive care staff, quality improvement experts, unit coordinators, nurse educators, and frontline nursing staff—to develop and implement a stroke care improvement plan.

Thibodaux Regional utilized the Health Catalyst^®数据操作系统(DOS™)和一套强大的分析应用程序，包括中风分析加速器，用于监测和分析中风护理，降低中风相关成本，改善临床结果。利用来自数据平台的数据，Thibodaux区域确定世界杯厄瓜多尔vs塞内加尔波胆预测了影响死亡率和干预时间的中风护理过程的可变性，以及导致患者被转移到其他设施的条件。

利用这些数据，脑卒中转型团队将减少门到ct扫描时间作为减少急诊分诊患者门到针时间(DTN)总体目标的一部分。在回顾了最佳实践并参与了Health Catalyst University™的加速实践项目后，卒中团队专注于与一线员工合作，以及护理和医生领导，以改善卒中识别，最大限度地缩短干世界杯葡萄牙vs加纳即时走地预时间，并为社区提供最高质量的护理。

Emergency department providers, nurses, and technicians took ownership of the work to improve the quality and timeliness of stroke care. Thibodaux Regional provided its interdisciplinary team education to improve early recognition of signs and symptoms of stroke, to recognize uncommon symptoms, and to identify the high acuity patient needing immediate transfer to higher-level care.

Thibodaux Regional incorporated process changes beginning in ED triage to improve stroke care. It implemented a stroke assessment scale and order set, standardized stroke team notifications, utilized protocol for tissue plasminogen activator (tPA) administration, and incorporated unique visual identifiers for patients with stroke to improve early recognition and reduce intervention times, including:

• Door-to-triage stroke alert.
• Door-to-provider evaluation.
• Door-to-lab results.
• Door-to-CT completed with results.
• Door-to-tPA administration.

The process changes, notifications, order sets, and algorithms to prioritize care were optimized to align with the ED triage registered nurse (RN) and provider workflows, ensuring priority interventions were completed within the first hour of stroke identification. When a stroke is suspected, the ED triage RN activates stroke alert sending an electronic notification to the ED provider, radiology, lab, and pharmacy departments. Stroke alerts are aimed at getting the stroke team to the bedside of the patient more quickly while simultaneously triggering diagnostic testing and potential medication needs. Automated alerts update radiology, lab, and pharmacy of patient status every three minutes, ensuring their readiness.

To reduce patient transfers, Thibodaux Regional now has a neurologist on staff. Staffing adjustments in radiology along with visual identifiers, ensure prioritization of CTs for patients with stroke, and timely communication of results directly from the radiologist to the ED provider. Additionally, Thibodaux Regional moved tPA from the pharmacy to the emergency department trauma cells, eliminating the time needed for pharmacist notification and medication preparation.

该组织利用分析加速器来监控影响中风护理的过程措施的性能，如上门到供应商评估、上门到ct和上门到针的时间。Using the analytics accelerator, Thibodaux Regional can quickly and effectively monitor the timeliness of interventions affecting mortality and transfer rates for patients with stroke (see Figure 1).

The ED stroke team uses data from the analytics accelerator to drive unified care, using data to identify successes and recognize areas for improvement. The stroke team, executive leadership, and care transformation teams use data from the analytics accelerator to monitor performance, providing feedback to physicians and nursing staff, ensuring everyone sees the direct link between intervention changes and patient outcomes.

RESULTS

Thibodaux Regional’s data-driven stroke improvement efforts have improved the consistency and timeliness of care provided to its patients, positively impacting clinical, operational, and financial outcomes.

• 33.8 percent relative reduction in mortality for patients who have had a stroke.
• $118K in cost savings, the result of a 23.7 percent relative decrease in average variable costs, and a 19.4 percent relative reduction in LOS for patients who have had a stroke.
  • 患者可以在家多呆39天。
• 门到针的时间相对减少48%，门到CT的时间相对减少21%。
• 自从中风改善计划实施以来，转移到其他急症护理机构的病人减少了一半。
• 25.3 percent relative increase in patient satisfaction scores, with current ranking at the 99th percentile.

“It is powerful to give staff the meaningful data they need to manage process and metrics daily—we can see a problem immediately instead of waiting days to obtain the data.”

– Danna Caillouet, RN, Director of Quality Improvement

WHAT’S NEXT

Thibodaux Regional plans to expand stroke improvement efforts to the inpatient setting, designating a stroke response team and order sets aimed at standardizing care. Leadership will continue to provide community education to prevent the incidence of stroke and help ensure timely recognition and treatment.

REFERENCES

1. Centers for Disease Control and Prevention. (2019).Stroke facts.
2. Harvard Medical School. (2017).Recognizing stroke early.