The NorthEast Cerebrovascular Consortium

Dedicated to Improving Stroke Systems of Care Across the Northeast

 

The NorthEast Cerebrovascular Consortium (NECC)

Dedicated to Improving Stroke Systems of Care Across the Northeast

   

The NECC 7th Annual Summit Poster Presentations

 

Do you have a best practice to share with your colleagues in the Northeast? Present a Poster at the next NECC Summit. Email necc@heart.org to find out more.

NOTIFICATION AND RESPONSE OF EMERGENCY MEDICAL SERVICES

 

Improvements in Pre-Hospital Stroke Care: Results from the Massachusetts EMS Stroke Quality Improvement Collaborative

Mirian Barrientos, MPH, CPHQ - Massachusetts Department of Public Health; Erin Kulick, MPH - Massachusetts Department of Public Health; Denise Daudelin, RN, MPH - Tufts Institute for Translational Medicine

Approximately half of patients with acute stroke signs and symptoms access their initial medical care through Emergency Medical Services (EMS). In 2009, The Massachusetts Department of Public Health initiated the EMS Stroke Quality Improvement Collaborative pilot project aimed at improving pre-hospital stroke care using a Quality Improvement Collaborative model, looking at five evidencebased stroke quality measures. Aggregate data from participating EMS agencies was analyzed from baseline to June 2012, on a quarterly basis to show significant measure improvement, as a proxy for improvement in the quality of pre-hospital stroke care.


ACUTE STROKE TREATMENT

 

Identifying Barriers to Meeting Door to Needle Times While Caring for the Acute Stroke
Carol Bissinger, BSN, RN, CEN and Erin Higgins, RN - AtlantiCare Regional Medical Center
A lean Project was executed to identify barriers to administering tPA within 60 minutes of the patient’s arrival time. This was a mock acute stroke event with a multi-disciplinary approach to improve the process and eliminate any time-wasting steps.
 
In-Hospital Morbidity and Spatial Neglect After Right Brain Stroke*
Kristen K. Maul, PhD1; Anthony Doss, BA1,2; Peii Chen, PhD1; Ann Kutlik, BA3; Mooyeon Oh-Park, MD1,3,4; A. M. Barrett, MD1,3,4; 1- Kessler Foundation Research Center, West Orange NJ; 2 - Meharry Medical College, Nashville Tennessee; 3 - Kessler Institute for Rehabilitation, West Orange, NJ; 4 - Physical Medicine & Rehabilitation, University of Medicine and Dentistry of New Jersey – New Jersey Medical School, Newark, NJ
Spatial neglect is associated with poor stroke outcome and increased length of hospital stay. This study explores the relationship between administrative indicators of stroke morbidity and presence of spatial neglect.
 
Implementation of a Dedicated Center for Neurological Emergencies within an Adult ED Setting
Mitchell J. Rubin, MD; Phyllis O’Neill, RN, BSN, FN-CSA; Geri SanFillippo, RN, BSN
Advancements in the treatment of neurological/neurosurgical emergencies have emerged quickly while hospital infrastructure in the US and worldwide have not kept pace. Of particular note are conditions requiring time-sensitive interventions to improve mortality/morbidity. Due to the sometimes challenging nature of differential diagnosis in patients with vague symptoms in a busy ED, Capital Health determined that a dedicated ED would provide an opportunity for assessment and treatment. The Center for Neurological Emergencies was established using the efficiencies of existing space, equipment, and human infrastructure. Program outcomes include improved compliance in t-PA administration to eligible patients, reduction in door to needle time, and a reduced inpatient length of stay.
 
The Diagnosis of Transient Ischemic Attack Varies by Neurologist

Deepa Bhupali, MD; Huma Sheikh, MD; Daniel Labovitz, MD, MS - Montefiore Medical Center, Bronx, NY
The short duration of symptoms and multitude of non-vascular mimics make diagnosis of transient ischemic attack (TIA) subjective and challenging. Physician practice and perspective may influence whether a patient receives the diagnosis of TIA. Pathophysiology is the same for TIA and ischemic stroke (IS). Therefore, the proportion of TIA versus IS diagnoses should be the same across demographic and clinical strata and theoretically should not vary between physicians or hospitals. The TIA-IS ratio, defined as the proportion of TIA among all TIA and IS cases, differs between hospitals and varies widely among board-certified neurologists, with vascular neurologists less likely to assign the diagnosis of TIA.

 

Thrombolytic Therapy in Stroke Patients with Cancer

Adam Kerestes; Angela McCall-Brown, MSN, APN, RN; Sheila Da Silva, RN; Shalini Bansil, MD - Overlook Medical Center

We analyzed the effects of intravenous thrombolytics in stroke patients with concurrent malignancies. Four of five patients responded well with no symptomatic hemorrhage. Current malignancy may not be a contraindication for IV thrombolysis in patients with stroke.Further studies are needed in this area.


CONTINUOUS QUALITY IMPROVEMENT (CQI) INITIATIVES

 

Development of an Inpatient Acute Stroke Response System
Marie McCune BS, RN Mount Auburn Hospital
The management and treatment of patients who develop stroke symptoms while in the hospital is not widely documented in the literature. In order to ensure that they are triaged and treated as efficiently as those patients presenting from the community, the implementation of a protocol for identification and management of in-hospital strokes is vital to improve patient outcomes and educate and empower healthcare providers to give timely, efficient, and standardized care for patients suffering from in-hospital strokes.
 
Development of a Linked Dataset to Analyze Stroke Systems of Care in Massachusetts
Erin Kulick, MPH - Massachusetts Department of Public Health; Thomas Land, PhD - Massachusetts Department of Public Health; Lee H. Schwamm MD, FAHA - Massachusetts General Hospital

The Paul Coverdell National Acute Stroke Registry has been funded by the Centers for Disease Control and Prevention and implemented by the Massachusetts Department of Public Health since 2005. The Coverdell program has assisted Primary Stroke Service designated hospitals in Massachusetts with monitoring and improving the quality of care for acute stroke patients through SCORE, an acute stroke quality improvement (QI) program developed in partnership with the American Heart Association. We sought to determine the feasibility of creating a linked dataset that will allow for analysis of patient outcomes across the stroke system of care.

 

Enhancing the Acute Neurologic Assessment for Stroke – the NIHSS

Karin Nyström, APRN, MSN; Cindy Bautista, RN, PhD, CNRN; Sabine Cayo, RN; Janet Halliday, RN, BS; Alyssa Yardis, RN, CNRN; Kristin Bullock, RN; Kristie Lianos, RN, CNRN; Carol Galanter, RN, BS; Kelly Poskus, RN, MS; Robyn Hewitt, RN, MSN - Yale New Haven Hospital and the Yale University School of Nursing
The National Institutes of Health Stroke Scale (NIHSS) is a valid, reliable, and efficient measure of a patient’s neurologic status during an acute stroke and in assessing outcome after treatment. Originally developed by researchers during the 1990s for acute stroke trials, this instrument has now become the “gold standard” for measuring stroke severity and is used as a predictor of patient outcome. The objective of this project was to provide training classes for nurses in the critical care and neuroscience units to become certified in the NIHSS. This tool would become the standard neurologic assessment for patients with an acute ischemic stroke or intracranial hemorrhage at Yale-New Haven Hospital (YNHH).

 

New Jersey State Designated Comprehensive Stroke Centers Comply Better with Joint Commission Core Stroke Measures than Primary Stroke Centers

Spozhmy Panezai, MD; Tefera Gezmu, PhD, MPH; Florence Chukwuneke, RN; Ratna Bitra, MD; Abate Mammo, PhD; Debra Virgilio, RN, MPH; Martin Gizzi, MD, PhD, FAHA

Compliance with Joint Commission Core Measures for stroke care are tracked in the New Jersey Acute Stroke Registry. This study shows that in New Jersey state-designation as a Comprehensive Stroke Center is associated with greater compliance with the core stroke measures and shorter door to thrombolytic drug times in comparison with Primary Stroke Centers. This may translate into better stroke care and improved outcomes for patients treated at Comprehensive Stroke Centers.
 
Regional Stroke Networks May Fill Gaps for Community and Quality Improvement

Nazli Janjua, MD; Shannon Melluzzo, BA; Charles Wira III, MD; Zainab Magdon-Ismail, Ed.M, MPH; David Day, BS; Louise D. McCullough, MD, PhD; Joel Stein, MD; Judith Lichtman, PhD; Toby Gropen, MD on behalf of The NorthEast Cerebrovascular Consortium

State departments of health (DOH) and professional organizations such as the American Heart Association (AHA) create guidelines that influence many aspects of the stroke systems of care (SSC); however, they may not directly address ongoing quality improvement (QI) efforts and community/professional education (CE) activities. Regional networks such as The NorthEast Cerebrovascular Consortium (NECC) may better liaise with hospitals to fill this gap.
 
Presented as a poster at the Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 2012 Scientific Sessions, May 9-12, 2012, Atlanta, GA

 

Results of The National Institutes of Health Train the Trainer Program in the Northeast

Lisa A. Bemben, MPH, CHES; American Heart Association/American Stroke Association; Shannon Melluzzo; American Heart Association/American Stroke Association; on behalf of The NorthEast Cerebrovascular Consortium.

The National Institute of Health Stroke Scale (NIHSS) is a systematic way of examining the acute stroke patient to determine stroke severity. In 2011, The NECC implemented an NIHSS Train the Trainer program with a goal of increasing the number of staff at participating hospitals that are trained to administer the NIHSS and to increase the number of patients that have a documented NIHSS score. The results of the year-long program will be presented.

 

Stroke Education across the Continuum – A Multi-Disciplinary and Multi-Modal Approach

Suzanne Lawrence, PT - Fletcher Allen Health Care (FAHC); Sharon Kenney, RN, - Stroke Program Coordinator FAHC, Mark Gorman, MD - Stroke Program Director, FAHC, Mike Kenney - Research Assistant, University of Vermont; Jennifer Pons, PhD
This multi-phased CQI project will describe the gaps in patient/caregiver stroke education and clinician knowledge in the pre-hospital and acute care hospital setting. An inter-disciplinary team and consumers group used a collaborative process to develop a new education standard, staff training modules and measure project outcomes. Preliminary data suggests that the new pre-hospital and hospital stroke education has had a positive influence on the stroke care experience.
 
Stroke Patients at Risk for Aspiration Pneumonia at South Shore Hospital*
Patricia Long, MS RN, Linda Cashman- Belton, MS, RD, CNSD, Clinical Dietitian with the Dept. of Nutrition and Food Service; Kevin Delorey, RN, CNE; Keriann Dorn, MS,CCC-SLP; Jackie Kilrain, PT, Director Rehab. Services; Quality Management; Terry MacDonald, PT, Supervisor, Rehab. Services; Beth Trahan, MS,CCC-SLP
A multidisciplinary aspiration precaution initiative was created to address this variation in the assessment and care of the stroke patient at risk for aspiration pneumonia. The goals of the quality improvement initiative were to: (1) Standardize the approach to swallowing assessment in both the ED and inpatient units; (2) Increase awareness of aspiration risk factors; and (3) Implement effective preventive measures to reduce the incidence of aspiration.At this writing, South Shore Hospital has demonstrated consistent and sustained improvement in the PSS dysphagia screening measure. In addition, periodic stroke patient case reviews are conducted which have not revealed any incidences of 30-day readmission for aspiration pneumonia for our stroke patients.

 

Swallowing Safety: “It’s No Gag”

Peter Jarosz, MA., MS., CCC/SLP; Josephine Bodino, RN, MPA, NE-BC – The Valley Hospital, Ridgewood, NJ

A simple water screening was established for emergency department nurses to screen “High Risk Stroke” patients prior to consumption of PO medication. This screening, completed prior to formal swallowing evaluation by Speech Pathologist, was established as a first step to minimize/eliminate the incidence of pneumonia and increased length of hospital stay secondary to aspiration. This protocol also ensures that all patients are screened in order to comply with the Get With The Guidelines expectations.


REHABILITATION AND RECOVERY

 

Sexuality After Stroke: Patient Counseling Preferences
Joel Stein, MD; Marni Hillinger, MD; Cait Clancy, BS; Lauri Bishop, DPT, New York Presbyterian Hospital – Columbia and Cornell, New York, NY

Sexual dysfunction is common after stroke, but is frequently not addressed by health care providers. The aim of this study was to examine patient preferences for counseling related to sexuality post-stroke and to characterize the impact of sexual dysfunction on stroke survivors.
 
Relationship of FIM Items to Discharge Home from Inpatient Stroke Rehabilitation
Teresa Baker, DPT1, Karen Courchene, PT, GCS1, Madeline Maglio, MS, OTR/L1, Debra Margolis, MS, OTR/L1, Jeff Wilson, Braun, MS, OTR/L1, Leslie Portney, DPT, PhD, FAPTA2, Anthony Guarino, PhD2 1 - Spaulding Rehabilitation Hospital Boston, MA; 2- MGH Institute of Health Professions, Boston, MA

Previous studies have analyzed either total scores or specific components of the Functional Independence Measure (FIM) as they relate to discharge destination. Few research studies have examined each FIM item as it relates to discharge disposition for patients with first-time cerebral vascular accident (CVA). We researched the relationship between each FIM item and the impact of other associated factors to determine which components strongly predict the likelihood to discharge home for this population.