The topic of sepsis has been realized among the last 20 years. A majority of patients with sepsis enter the health system through the emergency department, and health professionals need to provide evidence-based care. Within the health system, interdepartmental teams were formed with the purpose to set a system-wide standard to meet the evidence-based practice standards for sepsis. Participants were recruited from every department that was involved with the care delivery of emergency department patients with sepsis. The team developed a team charter to state the group objectives. A gap analysis was completed to set group priorities. The first priority was to develop a system-wide sepsis alert process. The Operational Excellence coach conducted direct observations and interviews at each system facility and then a sepsis alert plan was developed. Two hospitals volunteered to pilot the sepsis alert within their emergency departments, and education was completed at each hospital. Informatics nurses developed electronic medical record workflow and outcome elements to help the team with the process. The pilot process showed an increase in compliance for core measures and laid the groundwork for each hospital to develop an individualized process.
Background: Stroke programs are often developed and implemented in well-established health care facilities. Stroke coordinators and nurse navigators are essential leaders to ensure success of a stroke program. We aimed to establish strong culture of engagement in the care of stroke patients from day one of a new 160-bed hospital, by hiring a stroke coordinator and navigator to assist with developing a stroke program prior to opening the hospital. Methods: Five months prior to opening a stroke coordinator was hired and navigator was assigned to coordinate post-acute stroke care. A multidisciplinary stroke oversight committee was formed, which guided development of the stroke program and integrated leaders from all areas involved with direct or indirect stroke patient care. In the months preceding go-live; policies and order sets were implemented, stroke alert processes, specific to each unit, with scenarios were reviewed. All nursing staff completed eight hours of stroke education, including NIHSS certification prior to go-live. Additionally, six mock stroke alerts were completed with the assistance of our simulation and training center. Results: One hundred twenty-two patients presented and were diagnosed with stroke between hospital opening on 09/30/2021 and 06/30/2022. The majority of patients were diagnosed with acute ischemic stroke (AIS) or transient ischemic attack 115 (94.3%), age was 69.1±14.8 years and median NIHSS was 1 [IQR, 0 - 2]. Two patients were recommended for and received AIS treatment; one IV thrombolysis and one endovascular stroke thrombectomy. Thirty four patients were added to the stroke care pathway and closely followed for 90 days. The hospital was 100% compliant with all Get with the Guidelines (GWTG) STK measures, with the exception of CSTK-01 NIHSS at 78%. Additionally, all GWTG achievement measures and quality measures achieved at least 93%, except for dysphagia screening which was at 86% compliance. Conclusions: Developing a stroke program by integrating a stroke coordinator and navigator prior to hospital opening facilitated best practices for stroke systems of care from day one. This allowed a brand-new hospital to achieve similar levels of compliance on key GWTG measures compared to other stroke certified hospitals.
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