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Five hospitals that are part of CHI Franciscan Health, based in Tacoma, WA, recently received awards for their commitment to providing high-quality stroke care to patients. The experiences of these facilities hold lessons that can be replicated in other organizations.
The American Stroke Association has recognized Highline Medical Center, St. Joseph Medical Center, St. Anthony Hospital, Harrison Medical Center, and St. Clare Hospital for their efforts to meet quality measures related to the proper use of medications and other stroke treatments.1
The hospitals focused on nationally recognized guidelines and the latest scientific research to improve stroke care, says Christina Bradley, BSN, RN, stroke coordinator at CHI Franciscan. Hospitals throughout the system implemented changes recently, such as extending the time window for when stroke patients can receive emergent treatment.
In recent years, the practice has been able to provide emergent care up to six hours from the last time the patient was known to be without symptoms. However, recent research supports extending that time to 24 hours with a few caveats, Bradley explains. “CHI is extending that time frame at St. Joseph and is in the process of moving that time frame out to other facilities as well,” she says.
The health system also is working on shortening the time of arrival to the administration of tissue plasminogen activator (tPA). The faster a stroke patient receives tPA, the better the outcome. “We’re also working on swallow screening, making sure patients are safe to swallow,” Bradley says.
He notes that some stroke patients may struggle to swallow. To improve this process, Bradley says CHI Franciscan is working on improving the screening performed by nursing staff and speech therapists. “All of these things have shown improved outcomes, including decreased disability and an increased number of patients who can go home instead of having to go to some type of facility,” Bradley explains.
The American Stroke Association’s Get With The Guidelines-Stroke program is supported by published studies demonstrating its success in improving patient outcomes. The association says that more than 2,000 hospitals have entered more than 5 million patient records into the Get With The Guidelines-Stroke database since the program began in 2003.2
Implementing the stroke best practices changes was not as simple as sending a memo with the new protocol, Bradley says. CHI began with gathering a group of stakeholders at St. Joseph to create a pilot program. “It wasn’t enough to agree that this should be our new path. We had to have conversations about how to make things work logistically,” Bradley explains. She notes certain changes included things like making sure stroke patients go immediately in for a CT scan when they arrive at a facility.
“There was a lot of behind-the-scenes work done with all the stakeholders from emergency, imaging, neuro-interventional radiology, pharmacy,” she adds. “There were a lot of people involved.”
That work took a few months before the pilot could be launched at one hospital, Bradley notes. A key is making sure all the right people are involved. Otherwise, the process can be bogged down if a department or key player in the stroke treatment process balks at what the task group is doing or does not provide the necessary support, Bradley says.
In the pilot at St. Joseph, CHI Franciscan has achieved faster times in several parts of the stroke treatment process — the time from arrival to CT scan, the time to receiving imaging results, and the time to administer tPA. “We’ve gotten better at breaking our records for how quickly we can give the tPA. Everyone is getting involved and making it a team effort,” Bradley reports. “We’ve also seen on the back end patients have lesser disability and more patients who can be discharged home with no or very little disability. Seeing those patients go home and able to resume their lives with their families has been very rewarding.”
CHI Franciscan is expanding its stroke efforts to include better communication with EMS personnel, with representatives attending base station meetings and using other opportunities to educate them on stroke protocols and how to best work with hospital teams. Another project involves increasing the number of people who call 911 with potential stroke symptoms who actually go to the hospital.
“We see through triage people maybe not taking it seriously and not realizing that stroke is an emergency, if they come to the hospital at all. Our goal is to improve the percentage of people who follow through and get to the hospital through EMS,” Bradley says. “Going to the hospital with EMS is the best option for the patient because everything gets lined up, EMS can call us ahead of time, and the outcome of patients is better. That is one of our biggest goals going forward.”
The stroke improvement efforts at any single hospital are multiplied through the CHI Franciscan system, notes Dennis Wang, MD, stroke specialist. This is a substantial benefit for improving the quality of care for the largest number of patients in a fast way, he says.
“In a network of hospitals, everything is more uniform and standardized. We can work with EMS to encourage them to communicate with us quickly and in the same manner, no matter what hospital they are going to. Then, the treatment process is the same at all the hospitals,” Wang says.
He adds that because each facility uses the same radiology group, there is uniformity even in that process. “If the patient has to be transferred to another facility, the images are already available,” Wang notes. “All the information is in the same chart that we share.”
Financial Disclosure: Author Greg Freeman, Editor Jonathan Springston, Editor Jill Drachenberg, Nurse Planner Jill A. Winkler, BSN, RN, MA-ODL, Consulting Editor Patrice Spath, MA, RHIT, Editorial Group Manager Leslie Coplin, and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.