Abstract T P260: Utilizing Concurrent Chart Review With Electronic Medical Record to Improve Stroke Core and Quality Measures

Abstract

Background and Purpose: The purpose of this project was to utilize concurrent chart review with electronic medical record as one method to improve stroke performance measures. In order to standardize and improve stroke care in the acute care setting, stroke performance measures have been set forth by the American Heart Association/American Stroke Association through Get With The Guidelines Registry, and from the Joint Commission. Maintaining stroke measures above goal can present a challenge in the world of paper documentation and chart review after discharge. Electronic medical record (EMR) allows multiple providers, including physicians, nurses, therapists, and stroke coordinator to access the health record concurrently during the patient’s hospital stay. Methods: Guided by a successful program implemented by St Mary’s Health Center in Jefferson City, Missouri, a 2 step concurrent chart review process was initiated for all stroke and transient ischemic attack (TIA) patients admitted to our facility. A stroke coordinator conducted chart review via EMR focusing on 8 of the quality measures (Early Antithrombotics, venous thromboembolism prophylaxis, antithrombotics at discharge, anticoagulation at discharge for atrial fibrillation/atrial flutter, smoking cessation, statin at discharge, dysphagia screen, and stroke education). Chart review was conducted the day after admission and the day of discharge with the goal of correcting potential outliers on the same day of chart review. Monthly performance data was collected over 1 year. Results: Concurrent chart review was conducted on 409 stroke/TIA patients. There was gradual improvement in quality and core stroke measures following implementation with achieving and sustaining 100% in 7 measures by month 6 and acheivement of >90% for dysphagia screen. Conclusions: In conclusion, concurrent chart review with the use of electronic medical record allows the stroke coordinator to focus on core and quality measures, while allowing multiple members of the stroke team (physician, nurse, and therapist) to access the same patient record. This also provides opportunities for collaboration and process improvement within the same stroke team.