Abstract WP428: Inter-professional Process Improvement Initiative to Enhance In-hospital Stroke Alerts

Abstract

Background: Annually, 17% of all strokes occur during hospitalization. Compared to individuals with stroke who present to the emergency department, the prognosis for individuals with an in-hospital stroke is worse. Patients with in-hospital strokes experience higher NIHSS scores, Modified Rankin scores, and increased mortality rates. An inter-professional stroke committee conducted a process improvement initiative to enhance in-hospital stroke alerts and treatment rates. Methods: The Plan-Do-Study-Act model was used to guide this initiative. Upon initial review, outdated policies and procedures for in-hospital stroke alerts were identified. First, evidence supported the need to add a rapid response nurse to the stroke alert response team to facilitate immediate care of patients, to transport them to CT and the Stroke Unit. Second, the process for hospital staff to call stroke alerts was revamped. An educational program was designed to empower all clinical and non-clinical staff members to call in-hospital stroke alerts. The program included ACT FAST education and the new in-hospital stroke alert procedure. A variety of training modes were used to disseminate the education: new hire orientation (n=836), in-services (n=257), and computer-based learning (n=903) for a total of 1996 staff members trained from February-August 2018. Results: Post-training data collection is ongoing; however, preliminary analysis has been conducted. Prior to the education about the new process, 70 stroke alerts were called, 12 were accurate (17%) and 4 were treated (33%). During the education period, 56 stroke alerts were called, 18 were accurate (32%) and 6 were treated (33%). Currently, all employees receive in-hospital stroke alert training during orientation and annually. Monthly inter-professional stroke committee meetings include monitoring of the new process allowing for timely discussions and adjustments. Conclusion: The goal of the initiative has partially been met by using a team approach and the Plan-Do-Study-Act model. Improvements in stroke alerts accuracy have been observed while treatment rates are currently similar. Updates to the process were possible with collaboration among team members to improve outcomes for the in-hospital stroke patients.