Team # 927 -- Stroke Program
College of Medicine

February 2010

Objective

To screen all stroke patients for difficulty in swallowing and to reduce the acute stroke patient transfer time from outside hospitals.

A. Dysphagia screening on all stroke patients - aspiration pneumonia is common complication of stroke patients, we had rate of >7%; this is also a Joint Commission requirement for maintaining our certification as Primary Stroke Center. The objective that we achieved was to ensure compliance with nursing screening >90% of stroke patients through focused education, multidisciplinary support, and commitment from nursing administration for accountability support.

B. Reduction of acute stroke patient transfer time from outside hospitals. This was identified as an opportunity to increase the number of patients who qualify for advanced stroke intervention by standardizing and streamlining the transfer process. The objective we hope to achieve and have seen early progress with is to reduce the time from @ 2 hours to less than 1 hour. This has involved collaboration with Life Lion flight crew (new stroke protocols and commitment to being dispatched for stroke transfers), establishment of a regional stroke coordinators' group to gain consensus and buy-in from the outside hospitals and to create standard guidelines and a checklist for transfer, changes to our MD Network scripting for incoming consultation calls, and commitment from our ED leaders to provide a triage bay for initial evaluation and treatment on arrival here.

Team Membership

  • Kevin Cockroft, Co-director
  • Kathy Morrison, Manager
  • Raymond Reichwein, Co-director
  • Gayle Watson, Coordinator

Results Achieved to Date

  • ExpectedResults:
    A. The result was a 36% reduction in aspiration pneumonia - from 7.4% to 4.7%. The measures of performance are completion of the swallow (dysphagia) screen powerform along with incidence of aspiration pneumonia. We continue to track these measures and report quarterly to Core Stroke Team, Stroke QI Team, and Neuroscience Unit Practice Council. We've begun the process of using this effective screen for all at-risk patients throughout the hospital - not just stroke patients.

    B. We have reduced our time from 2 hours to 86 min within 6 months of initiation. We have also developed open communication/support relationships with more of the Eds around us. We anticipate as we reduce this time further, we will demonstrate a higher advanced treatment rate. The measures of performance for this project are the turnaround times as logged by the Life Lion crew and the advanced intervention rate. We will track and report this to our Core Stroke Team, Stroke QI Team, Life Lion personnel, regional coordinators' group, and Neuroscience Unit practice council.

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