Abstract
Background: Evidence-based studies illustrate the effectiveness of specialized stroke services in improving stroke patient outcomes. The American Stroke Association (ASA) has recommended the development of primary (PSC) and comprehensive (CSC) stroke centers to ensure that organizations have the expertise and resources to provide stroke care. Purpose: Cohorting (grouping) stroke and transient ischemic attack (TIA) patients on a dedicated neurological intensive care unit (ICU) and providing continuum of neurological patient care through the stroke unit has shown to improve patient outcomes through 90-100% compliance with stroke core measures and Get With The Guidelines ( GWTG ) quality measures. Methods: The ICU redesigned and selected eight neurological beds; while simultaneously, the medical/surgical stroke unit transitioned to include neuroscience/telemetry. The transition utilized the theoretical framework of Appreciative Inquiry (AI) to promote positive culture change. Through the dedication of nursing leadership, stroke coordinator and neuro educators, a comprehensive education plan was executed for all registered nurses of these units. Through utilization of coordinated NIHSS during change of shift and inter-department report, subjective differences were eliminated and baseline assessment created consistently. A neuroscience task force established and incorporated nurses from emergency room, intensive care unit and neuroscience/telemetry unit to facilitate collegiality and stroke patient care continuum. Results: Examination of the Stroke Core Measures and GWTG quality measures pre and post the transitions confirmed improved compliance with ASA’s stroke core measures and quality indicators. In addition, the patient length of stay decreased well below the national average and 30 day readmission rate decreased as well. Conclusions: The benefit from treatment in a dedicated stroke unit remains a key component of improved outcomes. Therefore, creating a coordinated stroke/TIA continuum of care from door to discharge has exhibited improvement of the core measures and quality indicator compliance thus improving patient outcomes.
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