Abstract TP390: Continuous Quality Improvement Implementation Across a Large Stroke Network of Affiliated Rural Hospitals Demonstrates Improved Care

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Abstract

Background and Purpose: Currently, the stroke care network includes 28 affiliate hospitals. One of the network missions is to improve quality of care through an evidence-based, standardized approach. In 2014, a formalized continuous quality improvement process began.

Methods: Each affiliate receives quality education and utilizes a data report to collect and submit monthly stroke data elements quarterly. Data were compared for system analysis.

Results: 18 of 24 (75%) affiliates submitted data in 2014, compared to 23 of 26 (88%) in 2015. For STK[PM]-7: dysphagia screening, 42% of the affiliates submitted data in 2014, compared to 73% in 2015. Out of the hospitals submitting inpatient data for both years, the average for all appropriate measures was 84% in 2014, compared to 88% in 2015. Of these, 27% (4/15) improved, 60% (9/15) remained the same and 13% (2/15) worsened on these inpatient measures. For CT interpretation time (< 45 minutes), the average time was 50 minutes in 2014, and 52 minutes in 2015. 55% (6/11) improved on the CT interpretation time and 45% (5/11) worsened. For Door to Needle time (< 60 minutes), the average time was 89 minutes in 2014, and 65 minutes in 2015. 70% (7/10) improved on the Door to Needle time and 30% (3/10) worsened.

Conclusions: The network showed substantial improvement with the CQI program in: data submission rates, CT interpretation time, and Door to Needle time. Additionally, for inpatient measures, 87% of affiliates who submitted data for both years improved or remained the same. This is a great success overall. We believe this reflects focused improvement efforts at individual affiliates and network-wide. Areas for focus in the next year were determined: Door to Needle and CT interpretation times, STK-4, STK[PM]-7 and quality of abstraction.

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