Abstract Details

Title Improving Performance Metrics in Acute Stroke Care by Use of Standardized Stroke Templates

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-010

Objective This quality improvement project aimed to improve the timeliness and accuracy of in-hospital stroke documentation in order to improve quality of care and use for research purposes.

Background Barrow Neurological Institute is a high-volume primary stroke center with mechanical thrombectomy capability. As an academic center, neurology residents comprise an essential part of patient’s inpatient stroke care. Documentation varied among neurology residents regarding the timeline and details of information documented in the initial H&P, progress notes, and discharge summary. As such, there was a wide disparity in the data captured on stroke patients.

Design/Methods

Standardized stroke templates were created to include designated fields pertaining to the time course and severity, allowing consistent and accurate determination of NIHSS and ICH score. This QI project is divided into 2 PDSA cycles. The first cycle implemented the standardized templates to be used on all stroke patients. The second cycle implemented further actions such as educating temporary neurology rotators and intermittently reminding neurology residents regarding the use of templates with printed handouts.

Results

Prior to implementation in March 2019, a pre-implementation period of six months was captured as a baseline population data set, which revealed significant deficits in timeliness of NIHSS and ICH scores. After the first cycle was implemented, a statistically significant improvement (p < 0.05) in the timeliness and accuracy of NIHSS as well as ICH score upon initial arrival. After implementation of a second cycle, a statistically significant improvement was (p < 0.05) was noted for NIHSS at 24 hours without a decrease in other quality metrics.

Conclusions Implementation of a standardized documentation for all stroke patients results in greater accuracy and timeliness of stroke patient data.

Authors/Disclosures
Liang Wang, MD (Dignity Health Northridge) PRESENTER	Dr. Wang has nothing to disclose.
Alison Kostandy, MD (Indiana University, Neuroscience Institute)	Dr. Quan has nothing to disclose.
Yazan Al-Hasan, MD, PhD (St. Joseph's Hospital and Medical Center)	Dr. Al-Hasan has nothing to disclose.
Xiao Weng, MD (Trinity Health of New England)	Dr. Weng has nothing to disclose.
Justin Hoskin, MD (Barrow Neurological Institute)	Dr. Hoskin has nothing to disclose.
Shane Root, MD (Barrow Neurological Institute)	Dr. Root has nothing to disclose.
Melissa R. Balbuena-Root, MD (Real Time Neuromonitoring Associates)	No disclosure on file
Michael F. Waters, MD, PhD, FAAN (Mount Sinai Scholl of Medicine)	Dr. Waters has nothing to disclose.

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