Abstract WP415: Electronic Stroke Care Pathway Significantly Increases Quality Improvement Metric Documentation and Patient Education

Abstract

Introduction: Stroke accounts for 1 in 20 deaths in the US, and increasing stroke healthcare costs are projected to rise to $185 billion yearly by 2030. Care Pathways use standardized electronic medical record (EMR) documentation, order sets, and clinical decision support to streamline institution-wide care delivery and have been shown to improve outcomes. We hypothesize that the Acute Ischemic Stroke (AIS) Care Pathway increases EMR documentation of quality improvement metrics. Methods: The AIS Care Pathway was implemented starting in 11/2015. It streamlines workflow by providing users with EMR documentation tools, order sets, and clinical aids. We compared the documentation of quality improvement metrics in patients on and off the Care Path, including stroke education and documentation of last known well (LKW), NIH stroke scale (NIHSS), and modified Rankin Scale (mRS). Results: In 2017, 2,728 patients were diagnosed with AIS; 77% of patients were placed On Care Path, and 23% were Not On Care Path. Documentation of LKW (81% vs 29%, p<0.01), admission NIHSS (100% vs 62%, p<0.01), admission mRS (99% vs 60%, p<0.01), discharge NIHSS (75% vs 46%, p<0.01), and discharge mRS (78% vs 49%, p<0.01) were significantly higher for patients On Care Path compared to those Not On Care Path (Table 1). Likewise, a higher proportion of patients On Care Path received nursing stroke education (74% vs 48%, p<0.01). Conclusions: AIS Care Pathway significantly increases documentation of quality improvement metrics and education related to stroke care. These are electronically abstracted data that can eliminate the need for manual abstraction.