Background In 2013, a telestroke program was initiated within our hospital system. The Clinical Nurse Specialist (CNS) led the interprofessional team to implement the telestroke program at the spoke facility. Prior to implementation the hospital never successfully gave tPA in less than 60 minutes.
Purpose: Implement telestroke into existing processes to ensure early access to neurological consultation and improve D2N time for eligible patients.
Methods The CNS used the National Association of Clinical Nurse Specialist’s core competencies to help guide the implementation of telestroke. Collaboration: established shared vision and goals between the hub and spoke to identify and optimize outcomes. Collegiality: identified and engaged key stakeholders. System leadership: managed interdisciplinary workflow, empowered others to influence clinical practice. Evaluation of clinical practice: defined key goals and metrics, monitored data, provided feedback to clinicians and disseminated performance metrics. Consultation: local expert on existing processes, provided data analysis and quality monitoring to assess effectiveness of the program. Research: identified best practices, used evidence to drive process changes. Ethical decision making: provided clinician education to ensure competence with new equipment and processes while maintaining a patient centered approach. Coaching/direct patient care: provided bedside assistance to clinicians.
Results Visibility of CNS influence on the redesign of the stroke patient care delivery process is evident in the following outcomes: time to activation of neurology consult reduced by 20 minutes, since implementation tPA given in < 60 min 68% of the time.
Conclusions The CNS utilized core competencies to successfully implement telestroke. The redesign of this care delivery process required the CNS to influence the care for complex stroke patients, empower clinical staff to change practice and create a system wide approach to care of stroke patients. As a result, patient outcomes improved, demonstrating CNS impact on the safety, efficiency, reliability and quality of care for these complex patients.