Abstract 172: Stroke Clinical Champions and Quality Improvement

Abstract

Objective: Clinical champions may serve as important facilitators of clinical quality improvement. We sought to understand how stroke clinical champions communicate within and between clinical services among providers of acute stroke care which spans clinical services. Methods: We conducted semi-structured, in-person baseline interviews with clinical providers of acute stroke care services and related administrators and service managers across 11 VA Medical Centers across the US. We consented the responders and audiotaped the interviews. Closed ended question responses were entered into a database and open ended question responses were transcribed and qualitatively coded. For qualitative data, we assigned at least two coders per transcript for analysis. A priori, we operationalized key constructs of stroke quality improvement and utilized these constructs as an initial coding scheme. Additionally, we coded emerging themes from the qualitative responses using Nvivo software. Coders met regularly to review and consolidate when possible the emergent themes. Results: We completed 104 interviews of which the respondents included the following service lines: neurology, emergency department, inpatient care, education, social work, quality improvement, rehabilitation. Qualitative analyses indicated that 5 of the 12 facilities had unanimously identified stroke clinical champions. These sites reported more frequent communications within neurology service and stronger communications across service lines. Respondents external to the neurology service line were more likely to identify the presence of a stroke clinical champion at VA facilities that had established acute stroke care processes across the medical center compared to facilities where no systematic acute stroke care processes currently existed. Conclusions: A stroke clinical champion may be associated with the establishment of systematic clinical processes that span interdisciplinary services within an organization. The coordination of such interdisciplinary care and the brokering of interdisciplinary relationships may need a clinical champion to foster. Impact: Understanding the development of a stroke clinical champion is crucial for organizations that seek to improve their clinical processes.