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.
Introduction: Prior studies have found conflicting results in regards to whether air or ground transportation to transfer stroke patients is associated with quicker door-in-door-out (DIO) times. We aimed to examine DIO times in acute stroke patients from two community primary stroke centers (one with air/ground; one with dedicated ground transport only) from a similar geographical location. Additionally, we aimed to examine whether there were differences in DIO comparing the hospitals. Methods: We prospectively collected and retrospectively analyzed stroke transfer data from two community hospitals in a health system between 10/1/2018 and 03/31/2020. A hierarchical logistic regression was performed in two steps to determine which factors were associated with DIO ≤ 90 minutes. First, possible confounding variables such as age, gender and arrival mode (EMS or private vehicle) were entered. Next, we entered variables of interest; transfer mode (ground vs air), if the patient was transferred for mechanical endovascular reperfusion (MER) and if the patient was transferred from the hospital with dedicated ground transport or not. A subgroup analysis determined if DIO differed between hospitals. Two-sided Fisher’s exact test examined proportion of DIO ≤ 60 minutes comparing hospitals. Results: During the study 334 patients were transferred [234 hospital with air/ground (100 air, 134 ground) and 100 hospital with dedicated ground transport]. We found that patients were more likely to be transferred within 90 minutes of arrival if: transferred by air, OR = 14.99 (95%CI 4.34 - 51.76) p < 0.001; transferred for MER, OR = 2.97 (95%CI 1.37 - 6.46) p = 0.006 and transferred by dedicated ground transport, OR = 14.93 (95%CI 4.35 - 51.30) p < 0.001. A subgroup analysis suggested that there was no difference in DIO between patients transferred by air or dedicated ground (p = 0.88). Although, we found significantly more patients were transferred within 60 minutes by the hospital utilizing a dedicated EMS (6.0% vs 1.3%), OR = 4.92 (95%CI 1.20 - 20.06) p = 0.02. Conclusions: In conclusion, a dedicated ground transport ambulance allowed for quicker DIO times overall, including a greater proportion of all transfers within 60 minutes but similar DIO times to MER patients transported by air.
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