Abstract WP452: Nurses Use Real-Time Patient Identification Tool to Improve Care Coordination for Transient Ischemic Attack Patients

Abstract

Background: Programs emphasizing early evaluation and management have reduced 70% of transient ischemic attack (TIA) patients’ recurrent events. One barrier to guideline-concordant care is inadequate care coordination. Purpose: Our objective was to evaluate adoption of nurse care coordination programs on TIA care quality at two Veteran Health Administration (VHA) facilities. Methods: Nurse care coordination programs with real-time patient identification and using Consolidated Framework for Implementation Research (CFIR) to guide local adoption, were evaluated at 2 VHA facilities. Programs were coordinated by an Emergency Department (ED) Nurse Navigator or Neurology Stroke Nurse Coordinator. The nurses used a Patient Identification Tool which was updated daily and displayed: TIA patient’s name, event and discharge dates, diagnosis, visit type (ED or inpatient), and primary care team. Nurses reviewed patients’ charts for key care components (e.g., medications), identified gaps in care, and provided follow-up. TIA care quality was evaluated by Without Fail Rate (WFR) which describes the facility-level proportion of patients who received all eligible processes of care (anticoagulation for atrial fibrillation, antithrombotics, brain imaging, carotid artery imaging, hypertension control, moderate/high intensity statin, neurology consultation). Results: We compared the WFR before (Fiscal Year [FY] 2017) and after (FY2019) implementation of the care coordination programs: Site-1, 59.6% (N=48) to 71.4% (N=30), p=0.332 (not significant); Site-2, 15.9% (N=47) to 38.5% (N=29), p=0.045 (significant). The individual process of care with greatest improvement was high/moderate potency statin at Site-1 (68.4% to 82.6%, p=0.250 [not significant]) and neurology consultation at Site-2 (39.5% to 80.8%, p=0.001 [significant]). Conclusions: Nurse care coordination programs using real-time patient identification were associated with improved quality of care. These broadly generalizable programs were important components of a comprehensive, multidisciplinary quality improvement initiative. Healthcare systems interested in improving care for TIA patients may find real-time patient identification useful in coordinating their care.