Abstract
Background: Stroke care involves a costly and time-sensitive interdisciplinary approach, which requires a supportive platform in order to explore novel patient care strategies. Our initiative aims to reduce costs and poor outcomes for stroke patients through increased coordination across the continuum of care. Methods: This innovative care model includes an inpatient component, Stroke Central. Stroke Central utilizes an intra-professional team of specialists, including vascular neurologists, advance practice nurses, and a registered nurse (RN) coordinator who serves as the central contact to handle all stroke-related concerns from staff and patients. The goal of Stroke Central is to provide comprehensive monitoring of patients throughout care, resulting in early detection and intervention in any complications. The role of the RN coordinator is vital as a facilitator for Stroke Central communication, care monitoring, and ongoing education and training among patients and healthcare professionals. The RN coordinator is charged with improving compliance with standard of care guidelines throughout the continuum of care and collaborating with other team members to monitor patients both remotely and directly. Results: After initiation of Stroke Central, results show improved patient outcomes for the 434 patients seen in the first two quarters of 2013 compared with the 822 patients seen in 2012. Lengths of stay indices have decreased in cases of hemorrhagic stroke (10%), ischemic stroke (19%) and transient ischemic attacks (31%). Complication and mortality rates in hospitals have also decreased; expected complication rate index for ischemic stroke decreased 10%, while the risk adjusted mortality index for ischemic stroke decreased 40%. Initial cost analyses indicate decreased costs for the inpatient component. Conclusion: Having a dedicated staff member, as a first and continual facilitator for contact has been essential in this innovative model. Incorporating this key role into primary stroke care can lead to an overall improvement in stroke outcomes in diverse hospital settings.
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