Efficiency of acute ischemic stroke care pays off
Efficiency of acute ischemic stroke care pays off
LOS has dropped almost two days, but costs remain the same
By Connie F. Parliament, RN, BSN, CNRN
Neuroscience Care Coordinator
St. Joseph Mercy-Oakland
Pontiac, MI
Acute ischemic stroke (AIS) care changed in July 1996 with the advent of thrombolytic therapy.
The medical community's approach progressed from one of "wait and see" to emergent evaluation and treatment. In light of the new treatment option available for acute strokes and the requisitions of diagnosis-related groups, it became apparent that the need for speed and efficiency was crucial. Actions were taken to coordinate a multidisciplinary team to increase efficiency in the medical management of the AIS population.
Until recently, stroke patients had been managed on general wards for treatment and supportive care. The first step in developing a more efficient stroke program started with a Neuroscience Care Coordinator working with the team to move patients along the continuum of care.
Next came the congregation of the AIS population into an ortho/neuro unit, where specific education was provided for the staff. The development of a four-day length of stay (LOS) clinical pathway increased efficiency regarding treatments and testing, starting in the emergency department. (See sample pathway, pp. 136-138.)
Standing order sets — including rehab consultations, therapy evaluations, and diagnostic testing — helped improve the efficiency of patient care. Before the improvement program, physical therapy was offered five days a week on this unit; now, physical therapy is offered seven days a week.
Also, therapies now occur earlier in the patient's stay. Data show that the average time until an initial evaluation for physical therapy has decreased by .7 days; the average time to dysphagia evaluation has decreased by one day; and the average time to speech/language evaluation has decreased by 1.3 days.
The average LOS for the AIS population has decreased from 6.4 days in 1997 to 4.9 days in 1999. The average cost per case remains static, possibly due to more therapies being completed in spite of the decrease in LOS. Improving the quality of care in the AIS population also has led to increased staff and patient satisfaction as indicated by Parkside and Gallup data surveys.
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