Abstract NS22: Stroke Length of Stay: Life in the FAST Lane

Abstract

The length of stay for stroke (ischemic & hemorrhagic stroke DRGs combined) was 7.04 days in a major university teaching hospital, compared to the national average of 3-5 days. The purpose was to decrease length of stay (LOS) for the stroke patient population by implementing multidisciplinary LOS guidelines. Discharge planning starts with admission, and research shows a correlation between initial National Institutes of Health Stroke Scale (NIHSS) and discharge disposition. Patients with NIHSS = 0-5 most likely go home; 6-15 most likely go to a rehabilitation facility; and 16-42 most likely will go to a Skilled Nursing Facility (SNF) or Long Term Acute Care Facility (LTAC) (Schlegel et. al., 2004; Schlegel et al., 2003). We formed a multidisciplinary team, including nursing, social work (SW), care coordination (CC), medical hospitalists, neurologist, and physical medicine staff working specifically with the stroke patient population. Each discipline developed length of stay guidelines, depicting crucial points in the care of a stroke patient on a day-to-day basis (Wojner & Alexandrov, 2000). Each specialty was included in the teaching plan, and we held educational sessions for all disciplines, including 100+ members of the medical hospitalist team. Through this education, Nursing began communicating admission NIHSS in daily huddles. Palliative care screenings were included for patients with NIHSS >25. Speech Therapy (ST) recommendations for PEG tube placement were communicated daily, and physicians were notified directly. PT/OT/ST coordinated one discharge recommendation by day 2, with variances communicated immediately to the CC. For physicians, PEG scheduling was centralized since specific GI MDs were only available on certain days. Through implementation, our length of stay for all stroke patients went from 7.04 to 5.23 days. The LOS guidelines are now used to orient new team members from all disciplines.