Background and Purposes: Geisinger Community Medical Center is located in Scranton, Pennsylvania. We serve six counties with a population of 700,000. Due to the Scranton aging population, the incidence of stroke is 1.3 x the national average. We began our stroke program in March 2011 and grew to one of the best stroke programs in this region. Here, we describe our strategies leading to our success.
Subjects and Methods: To achieve our goal ,beside employing routine strategies such as ongoing hospital-wide education and monthly stroke meetings; we took the following intuitive steps: 1. Recruited a stroke program coordinator who was a RN with a post-graduate degree, certified in neurological nursing and rehab counseling with substantial experience in working in a trauma unit 2. Consistent presence of the stroke coordinator in the ER and an office on the stroke floor. 3. Developed a collegial relationship with all team members 4. Bottom-up approach to gain the trust and support of nursing staff and administration 5. Consistent real-time chart review of neurology / neurosurgery consults and scanning the emergency department patients’ list . 6. Develop an organized Feedback / Performance Improvement in stroke care. 7. Weekly Rehabilitation Collaboration Meeting. 8. Kept the ER medical service highly engaged in our stroke program by having regular meetings and offering on-site education and feedback 9. Recruited a Nurse Navigator and a Data Analyst.
Results: Geisinger Community Medical Center became a Joint Commission designated Primary Stroke Center and obtained a Gold Plus status in 2013. Since then, the number of treated stroke patients has increased to greater than 550. We have met the American Heart and Stroke Association and Joint Commission criteria for over 90% (95%CI: 87.5-92.5) compliance for eight stroke core measures. Our intravenous thrombolysis rate significantly increased to 12.6% (95%CI: 9.8-15.4). We achieved Honor- Roll Elite award for decreasing Door to Needle time below 60 minutes in 2015.
Conclusions: Our experience indicates a few simple strategies, can make a big difference in stroke care in community hospitals. A fledgling stroke center can rise from Zero to Gold Plus with Elite Status with careful planning, coordination and caring.