Background: As a Comprehensive Stroke Center (CSC), The Joint Commission requires post-discharge follow-up phone calls to be conducted within 7 days of discharge for all complex stroke patients. Purpose: To develop and sustain a feasible approach for Hospital Based Specialist (HBS) physicians to conduct follow-up phone calls within 7 days. Methods: A baseline evaluation of all post-discharge phone calls was conducted. It was determined that patients were receiving several phone calls already, therefore the team did not want to add an additional call to meet compliance. HBS calls were realigned to include a stroke-specific focus, reinforcing stroke education and secondary prevention. Calls were made within 7 days by the discharging physician. All stroke patient types discharged with a stroke diagnosis were contacted regardless of severity. Patients discharged to skilled nursing facilities, board and care, acute rehabilitation or other acute care hospitals were excluded. A templated note was developed to ensure all stroke-specific components were covered. All HBS physicians were trained. Telephone interactions occurred between the patient, family member, and/or caregiver. Those unable to be reached but had messages left or secure messaging sent were counted as compliant. Reminders were sent out to physicians to improve call compliance. Tracking occurred weekly for call compliance and note template utilization. Results: Between January 2018 and May 2019, 612 patients discharged home from the acute care setting. Of those, 55% (334) were contacted. Of those, 73% had the templated note documented. Several hurdles were encountered along the way, but utilization of the templated note and physician reminders improved compliance. Conclusion: Post-discharge follow-up phone calls initiated by HBS physicians and utilization of a templated note are a feasible means of meeting and sustaining the CSC requirement.
Background: Designated Stroke Centers are required by The Joint Commission to evaluate all acute ischemic stroke (AIS) patients for rehabilitation prior to discharge. Timing of this evaluation is controversial. Purpose: To evaluate the feasibility and safety of having a Physical Therapist (PT) or Occupational Therapist (OT) evaluate AIS patients within 24 hours of alteplase administration. Methods: Based on a comprehensive literature review, various committee discussions and agreement, the PT/OT team initiated evaluations within 24-hours for AIS patients treated with alteplase. The target post-alteplase evaluation time was 12-hours. Medical stability was determined by the physician as evidenced by an initial request for PT/OT evaluation. Prior to the evaluation, the therapist performed a thorough chart review. Patients with unstable vital signs, a fluctuating neurological assessment, and/or inability to participate in therapies were excluded. During the therapy evaluation, reassessment was ongoing. If any adverse change was observed, the evaluation was immediately stopped, the patient placed back in bed, and the primary nurse and/or physician notified. Results: A baseline review of data was performed. In 2016, 77 patients received alteplase, none of whom were evaluated within 24-hours following alteplase administration. Evaluations within 24 hours post-alteplase began in mid-March 2017 and continued through July 2018. A total of 103 patients received alteplase during this period, of whom 11 patients met initial exclusion criteria. Of these, 83% (76/92) were seen within the initial 24-hour timeframe. All patients reviewed and evaluated by the team were in the Intensive Care Unit. No mobility-associated complication or adverse neurologic change occurred during therapy evaluations or because of mobilization within the initial 24-hours. Conclusion: PT/OT neurological evaluations within 24-hours of alteplase administration did not result in adverse events or complications. Although difficult to quantify, therapy staff determined this change in practice was beneficial to patients as it allowed for earlier mobilization and initiation of the rehabilitation plan.
Background: Comprehensive Stroke Centers (CSC) are required by The Joint Commission to have an interdisciplinary peer review process. Most hospitals structure their peer review programs, also known as morbidity and mortality meetings, by specialty and not by Centers of Excellence. Often these meetings are closed, with minimal information sharing for making program-wide improvements. Purpose: To develop and implement a process for conducting morbidity and mortality reviews for a CSC based on best practices to foster improved clinical outcomes. Methods: A literature review was performed to establish best practices for such reviews. An interdisciplinary team including key stakeholders was developed for a non-biased comprehensive chart review. All deaths within 30-days, sentinel events, serious incidents, adverse events, close calls, stroke mimics treated with alteplase, delays in care, complications, and major complaints were reviewed. Cases were captured by formal and informal processes (see diagram). Outcomes and trends are monitored. Recommendations are made for changes in clinical processes. Results: Between January 2016 - June 2018, 853 charts were reviewed for the criteria discussed above. A total of 89 charts were referred to the committee for further chart review, of which, 3 were identified for department peer review. Of those 3 cases, all were determined to be outliers, and no trends have been identified . While there were no blatant opportunities identified for improvement, the review process provides helpful information regarding the quality of the program. Members of the interdisciplinary team feel that the process is robust and valuable. Conclusion: Establishing a succinct process for chart evaluation and interdisciplinary team review has proven effective in identifying cases for referral to peer review. These data have been helpful in improving performance and monitoring patient-centered outcomes.
Background: Comprehensive Stroke Centers are required by The Joint Commission to screen stroke patients with stroke for depression prior to discharge. Stroke related depression, however, may occur weeks or months after the acute event. Adding a 90-day screen may help identify additional patients with depression after discharge from the acute hospital setting. Purpose: To evaluate the impact of having a registered nurse (RN) perform 90-day post-discharge depression screening by telephone for patients with recent stroke. Methods: A team of RNs were trained on the Patient Health Questionnaires (PHQ2 and PHQ9). Both tools have been validated for telephone use. All ischemic and hemorrhagic stroke patients discharged home were included. Patients were called 90 days +/- 15 days post-discharge. Patients scoring positive on the PHQ2 (a score of > or equal to 3) were further evaluated by the RN using the PHQ9. Nurses referred patients scoring > or equal to 9 on the PHQ9 to the Stroke Medical Director for further evaluation. See graphic below. Results: Between August 2017 and July 2018, 297 patients were screened (56% of total stroke discharges, 297/527), of whom 8.8% (26/297) scored > or equal to 3 on the PHQ2. Of these, 73% had a PHQ9 score > or equal to 9 (19/26). All patients with a positive PHQ9 screen (19/19) were referred to the Stroke Medical Director and received appropriate triage and referral for ongoing care. This yielded a 6.4% rate (19/297) of stroke patients with symptoms of depression 90-days post-discharge. While some patients had a history of depression, most had no history or risk factors for depression. Conclusion: Conducting RN-facilitated 90-day post-hospital discharge telephone depression screening in patients with recent stroke appears to be an effective method to identify additional patients with stroke related depression who would not have been identified otherwise.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.