Abstract TP362: Stroke Order Set Utilization Improves Performance Measures and Decreases Length of Stay

Abstract

Introduction: Stroke quality programs aim to ensure patients receive evidence based care by measuring patient outcomes and adherence to core measures. Site specific stroke order sets embedded in EHRs augment core measure performance. The true benefit of stroke order sets on core measure performance is still an open question. We hypothesize that utilizing stroke specific order sets increases compliance to core measures and subsequently decrease length of stay (LOS) and readmissions. Methods: A retrospective cohort study was conducted, and included 1095 stroke patients discharged between May 1, 2017 and April 30, 2018. Hospital data was extracted from The Joint Commission stroke registry and supplemented with administrative data. The primary outcome was core measure compliance and was analyzed using Chi-square and Cochran-Mantel-Haenszel tests. Results: The majority of stroke patients (1009, 92%) had a stroke admission order set. Between the order set and non-order set groups there were significant differences in age ( p =.03), stroke type ( p <.001), and EHR system ( p =0.002). The order set group had a marginal decrease in LOS (days) compared with the non-order set group, 3 and 3.9, respectively ( p =.06). Unplanned readmissions within 30-days did not differ between groups ( p =.16). For ischemic stroke, phase specific order set usage showed significantly higher core measure compliance: venous thromboembolism prophylaxis (STK1) (94.0% vs 6.0%, p =.01), antithrombotic by end of hospital day two (STK5) (96.9% vs 73.3%, p <.001), discharged on statin medication (STK6) (99.8% vs 97.5%, p =.006), stroke education (93.3% vs 47.1%, p <.001) (STK8), and national institute of health stroke scale within 12 hours of arrival (CSTK1) (95.8% vs 44.1%, p <.001). The hemorrhagic stroke population showed no significant differences between order set usage and core measure compliance. Conclusion: Use of stroke specific order sets decreased overall LOS and increased compliance to STK1, STK5, STK6, STK8, and CSTK1 core measures.