Transcript Time Use Data to Improve Stroke Care

Time Use Data to
Improve Stroke Care
Terri Hamm RN
Stroke Team Coordinator
Mercy Medical Center, Des Moines
Why Data?
• Quite simply, data drives care
• You can’t know where you are going unless you
know where you have been
• Without process evaluation, there is no
opportunity for process improvement
• Best practices require constant data capture and
analysis
Stroke Data-What matters most?
• The Joint Commission currently has 8 performance
measures for acute stroke;
• VTE prophylaxis
• Anti-Thrombotic Therapy by Hospital Day 2
• Discharged on Anti-thrombotic Therapy
• Discharged on Cholesterol Reducing Medication
• Stroke Education
• Assessed for Rehabilitation
• Pt’s with A-Fib receiving anti-coagulation therapy
• Thrombolytic Therapy Administered
EMS Role in Documentation
• EMS is the first link in the chain of survival
• Hand-offs to ED staff/stroke team essential
• Clear and concise information assists in
determination of patient treatment options
• So what do we need from you???
Hand-Offs
• Give a heads-up to the ED that you are
transporting a possible stroke in progress
• Clear and concise description of symptoms
• Time of onset of symptoms if possible; if not,
we MUST have time last known well
• Glucose level
• Any medications or pertinent history that would
preclude the use of t-PA or require additional
lab tests particularly anti-coagulation use
Time is Critical
• Document time on scene; what delays occur that
a process change could assist with
• Document arrival to ED door; our clock for
treatment starts when you hit our door
• Document any meds/IV fluids/other treatments
initiated en-route
• Clear documentation of blood pressure and
heart rate; assists in triage decisions
Treatment Opportunities
• IV t-PA is the first line choice of treatment for patients
presenting within a three hour window from symptom
onset
• Extended t-PA window to 4.5 hours for subset of
patients that qualify
• Opportunity for Intra-Arterial t-PA or clot extraction
within 6 hours; may extend that time to 12 hours if
stroke is posterior circulation
• Research opportunities may extend window to 9 hours
in qualified subject
EMS Guidelines
• If within 30 minutes of a certified stroke center
patient should be routed there
• All stroke centers do not have the same capacity
for treatment of acute ischemic stroke and/or
hemorrhagic stroke
• Know the capabilities of the hospitals you
transport your patients to
• Document clearly if a patient or family refuse
transport to stroke center
The Wave of the Future
• Instead of door to needle times we will soon be
capturing times related to point of first medical
contact; for many patients that is EMS; the clock
starts with you; we will soon be required to
capture door to CT scan in our data sets
• Time is brain; we will be pushed to continue
searching for process improvement
opportunities that will shorten our times to treat
• How will we know if we are successful?
DATA!!!!!!
• The documentation you do on your run sheets is
important and often times the only source of
data we have in determining a care path
• We look at your run sheets and they matter!
• The more data we have the better the quality of
our assessments become and the more
opportunities there are for process improvement
In Conclusion
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What you do in the field matters
How you document matters
You are the first link in the chain of survival
In other words, it all starts with you!
Thank you for your dedication to our patients
and your communities
Questions??????
Have a great day! 