Abstract WP401: What Goes Around Comes Around

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Abstract

Background: Multidisciplinary rounds have classically consisted of the attending, advanced practice providers, residents and fellows. For most large comprehensive stroke centers (CSC), the stroke coordinator role is not intimately engaged in these teaching rounds thus disconnected from the team during focused discussions on care management. In order to advance the quality and comprehensiveness of patient care the stroke coordinator was added to clinical rounds.

Purpose: We propose allocating dedicated time to the stroke coordinator role for daily morning rounds with the stroke neurologist and team to increase compliance with quality care measures.

Method: Following the core and care team measures required for certification of a comprehensive Stroke Center, the stroke program manager selected three targets for improvement from the provider team and collected retrospective and prospective data for comparison once implementing the role change. Baseline patient data (collected the year prior to initiation of the stroke coordinator at rounds, was compared to patient safety and quality variables after initiation of rounds.

Results: The action of provider intervention triggered by scoring threshold in depression screening improved a yearly mean of 52% to 82%. The documentation of rTPA compliance went from a mean of 0% to 94%, The timely documentation of NIHSS as a severity score in acute ischemic stroke rose from a mean of 90% to 93%

Conclusions: Each of the metrics reflect Improvement over time. During rounds the coordinator would actively discuss gaps in care including documentation of eligibility for TPA, team action on patients with high scores on depression screening and timely documentation of NIHSS. In addition, the stroke coordinator reflected feeling more like a team member and not an "outsider looking in". It can further be hypothesized that the team remained very receptive to suggestions in the care of stroke patients, as the stroke coordinator was well known to them and available for questions and discussion each day. The closer role of stroke coordinator is still ongoing due to its success.

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