Abstract TP409: Continuous Quality Improvement Implementation Across a Large Stroke Network of Affiliated Rural Hospitals

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Background and Purpose: The stroke care network (SCN) currently includes 27 hospitals (one CSC, seven PSCs and four critical access facilities) and is responsible for nearly 7000 stroke discharges annually. Vital to our network’s mission is to improve care quality through a cooperative, evidence-based, standardized approach. Data submission began in February 2014 with 24 hospitals. The network compiled data results for a full year with a baseline purpose of analyzing submission and data trends.

Methods: All affiliates receive standardized quality education upon joining the SCN. A data report form was used to collect and submit monthly stroke data elements quarterly. Door to CT Interpretation (OP-23), eight in-patient stroke core measures and the dysphagia performance measure were among many other quality metrics. Data was compiled for system analysis.

Results: For calendar year 2014, 14 of 24 (58%) affiliate hospitals submitted data. The lowest scoring quality measures were STK-4: thrombolytic therapy (38%, N7), STK-8: stroke education (63%, N13) and (STK[PM]-7): dysphagia screening (59%, N6). Average time for CT interpretation was 46 minutes (range: 20-77 minutes). For stroke core measures, average was 73% for all appropriate measures (range: 38% (STK-4) - 88% (STK-2: discharged on antithrombotic)).

Conclusions: Data submission is not yet uniform across the network, but areas to focus on quality have already emerged from the results—STK-4, STK-8, and (STK[PM]-7). In addition to program advisory services to improve submission compliance, the network proposal includes focused initiatives as a system, targeting tPA, patient education and dysphagia screening. Strengths of the continuous quality improvement initiative will include collaboration, sharing of best practices and a strong base in evidence.

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