Abstract 48: Hospital Door To Rapid Follow Up, A Nurse Practitioner Led Model

Abstract

Introduction: The Neuroscience Institute is comprised of a Comprehensive Stroke Center and three Primary Centers. The healthcare team manages 1,800 hospital admissions yearly with expertise in acute treatment. However, door to rapid follow-up was not well defined. Literature review indicates expeditious post-stroke visits, a structured path to clinic, standardized ambulatory management and clear communication across the continuum ensures best practice. Hypothesis: A defined post-acute stroke management model could be implemented with Nurse Practitioners (NPs). A principal objective was to facilitate a rapid ambulatory visit less than two weeks post-hospitalization. Methodology: NPs were hired in 2019, then trained in acute and outpatient clinical rotations with Vascular Neurologists and inpatient Neurology NPs. Ambulatory NPs created a comprehensive guideline for sub acute visits. Content included: review of hospitalization, appropriate referrals, secondary prevention, functional assessments, medication adherence and stroke health literacy. Formal visit templates were imbedded in the electronic medical record, affording a consistent approach by NPs. Education templates were developed, with content personalized and provided to patients. Interval summary are completed by inpatient NPs; this includes a synopsis of stroke mechanism and acute intervention, neurological deficits, comorbid diagnosis and management plan at discharge. The summary incorporates a thorough review of core measures. A consistent process for scheduling rapid appointments was defined. Results: Data January to June 2021 demonstrated > 50% of patients completed rapid clinic appointments. Communication across the continuum was improved by electronic documentation and enhanced collaboration. There is a standardized approach to ambulatory management with individuation to patients. Expeditious outpatient visits are consistently occurring with an optimized process. Conclusion: NPs are essential stroke providers, closing gaps in the system of care in the acute and post-acute settings. A future goal is to increase the percentage of patients managed expeditiously, reducing incidence of cerebrovascular events thru a comprehensive ambulatory care model.