Abstract WP491: A Multi-Disciplinary Approach to Improve Transitions of Care

Abstract

Background and Purpose: In 2013, the Wisconsin Coverdell Stroke Program (WI Coverdell) initiated an analysis of EMS and hospital data. These examinations revealed opportunities for improvement in transitions of care (toc) for timelier stroke treatment. Due to the importance of pre-hospital triage and teamwork on stroke outcomes, WI Coverdell knew it was essential to conduct joint performance improvement among EMS and hospital staff. Methods: WI Coverdell’s 61 participating hospitals represent 77% of annual stroke admissions to Wisconsin hospitals. Coverdell hospitals participate in the quarterly Coverdell Learning Collaborative (CLC) where they review several aggregated data points. Of these, arrival to computed tomography (CT) initiation and door to needle (DTN) times are analyzed and discussed. Stroke Coordinators at hospitals’ performing at a high level share with the CLC their performance improvement (PI) activities and best-practices. Establishing a cooperative, trusting relationship with hospitals EMS services is essential. Since November 2013 many Outreach events to Coverdell participating hospitals acute stroke teams (AST) and their EMS service providers have occurred. These events aim to foster a trusting relationship between EMS providers and Coverdell hospitals AST. The Outreach event focuses on the toc from EMS to the hospitals, and emphasizes the important role of EMS in the stroke patient’s chain of survival. The areas of education for EMS providers include content on triage, treatment, and pre-notification to the hospital of the suspected stroke patient. The AST caregivers gain an increased awareness of EMS’s existing knowledge and triage processes that occur in the field. Findings: In analyzing annual data from 2013 to 2017 our multi-disciplinary approach demonstrates impressive results. For arrival to CT initiation, the median time decreased from 22 minutes in 2013 to 13 minutes in 2017. The percentage of acute ischemic stroke patients who received alteplase in 60 minutes or less increased 33.7% from 2013 to 2017. Finally, the N increased from 111 in 2013 to 359 in 2017. Conclusion: A multi-disciplinary approach focused on improving toc between EMS and hospitals have led to remarkable improvements in WI Coverdell’s outcome data.