Background: Geisinger Wyoming Valley Medical Center (GWV), in Wilkes-Barre, Pennsylvania, serves a population of approximately 320,000 people throughout Luzerne. In 2013, the stroke program was launched in GWV secondary to community need. In less than three years we achieved the highest quality metric from the American Heart and American Stroke Association. Here we describe highlights of our intuitive strategies and achievements.
Methods: The following strategies were employed to achieve this goal. The Stroke Program Coordinator was an emergency medical service provider and emergency department nurse manager. A stroke bay was added directly outside of the ED Computer Tomography(CT) suite, patients were immediately triaged and taken directly to CT. A nurse navigator was implemented for daily rounding to provide stroke education to patients and families and collect real-time data. The real-time data abstraction and feedback system allowed opportunity for immediate action and timely targeted education. Weekly in-services were held with the inpatient nursing staff where issues were further reviewed and education provided on an ongoing basis. Staff education has been the main priority and nursing management was closely involved. A systematic approach has been implemented for patients requiring weekend stroke education. A stroke topic was included in our monthly nursing newsletter.
Results: In less than three years we were able to achieve Target Stroke Elite Plus, the highest recognition from the American Heart and American Stroke Association. Sixty-seven percent (95% CI: 63.5-80.5%) of our acute stroke patients had a door-to-needle time below 45 minutes. Compliance with all our core measures more than 95% (95% CI: 93.4- 96.6%), and rehabilitation, in hospital antithrombotic treatment, discharge antithrombotic more than 99% of the time.
Conclusion: A collaborative model and multidisciplinary approach is associated with improved guideline adherence. In conclusion, this model and our strategies can be successfully applied in other community hospitals.