The NECC 11th Annual Summit Poster Presentations

Acute Stroke Treatment

Direct to CT Protocol Impacts Door to Needle Times
Jennifer Schleier, RN, BSN, CCRN, Michelle Vallelunga, RN, MSN, CNRN, Joshua Onyan, RN, Susan Rainbow, RN, BSN – Upstate University HospitalUpstate’s Direct to CT Protocol is aimed at presumptive and actual stroke patients in an effort to decrease door to CT times and subsequently door to needle times.

Endovascular Treatment in New York State: Before and After Updated Guidelines
Tara M. Cope, MS, Tatiana Ledneva, MS, Ian Brissette, PhD – New York State Department of Health
The goal of this study is to describe regional and state trends in endovascular treatments in New York State (NYS) before and after the release of the updated endovascular treatment guidelines in June 2015. Three-month rolling trends are calculated for the total number of endovascular procedures performed and the percentage of IS with occlusion cases treated using endovascular techniques in NYS. Stratified analyses describe endovascular procedures by hospital location, NYS stroke center designation, and teaching hospital status.

Informed Consent for IV tPA in New York State Designated Stroke Centers: A Current Snapshot
Michael I. Weintraub, MD – Phelps Memorial Hospital Center; Anna D. Colello, JD – New York State Department of Health; Samantha A. Johnson, MPH – American Heart Association | American Stroke Association; Fabienne McClellan, MPH – University of North Carolina Hospitals; Steven P. Cole, PhD -Research Design Associates; Curtis Benesch, MD – University of Rochester Medical Center; Steven H. Rudolph, MD – Maimonides Medical Center,Steven R. Levine, MD – SUNY Downstate Medical Center
The New York State Department of Health (NYS DOH) in partnership with the American Heart Association | American Stroke Association developed a quality improvement survey to study current informed consent procedures in both treatment windows among NY State Designated Stroke Centers. Investigators sought to ascertain if there is an association between IV tPA informed consent practices and hospital demographics among NYS DOH Stroke Centers.

Ischemic Stroke Snapshots in New York State: 2010 vs. 2014
Tara M. Cope, MS, Tatiana Ledneva, MS – New York State Department of Health
The objective of this study was to compare patient demographics, ischemic stroke hospital discharge rates, and treatments used for IS in New York State (NYS) for calendar years 2010 and 2014. The poster will show the results of stratified analyses for age, race/ethnicity, gender, and whether the patient was treated at a NYS stroke designation center. In addition, comparisons for the percentage of IS cases in NYS treated with recombinant tissue plasminogen activator and/or endovascular procedures will be shown for the entire state and by stroke designation center status for this same time period.

Lean Initiative: Direct to CT-Scan for Reduction in Door to Needle Time
Kimberly Hollender, ANVP, ACNP-BC, Judith Lane, SCRN, RN, Devon Lump, SCRN, ACNP-BC, Deborah Lord, SCRN, RN, Ray Bennett, SCRN, RN, Deviyani Mehta, MD, Igor Rybinnink, MD – Robert Wood Johnson University Medical Center
At Robert Wood Johnson University Hospital in New Jersey, a lean initiative was implemented to fast-track pre-activated Code Stroke patients directly to CT-Scan in an effort to ultimately reduce door to needle times. Barriers to this process included the distance to the CT-scan department, and concerns for patient safety in bypassing traditional ED triage. Ultimately, the direct to CT-scan process successfully reduced door to CT-Scan, and most importantly, door to IV tPA times while maintaining patient safety.

Quality Improvement: Responding to In-House Stroke STAT Calls
Dawn Beland, MSN, RN, Judy Greco-Dugan, BSN, RN – Stroke Center, Hartford Hospital; Mallory Mangan, BSN, RN, Abby Baecker, BSN, RN – N9 Stroke Unit, Hartford Hospital
Responding to acute in-house stroke (IHS) is infrequent and unfamiliar for most floor nurses. The key to stroke management is timely and efficient care, but stroke recognition, assessment and treatment is often delayed for IHS. Staff from the Stroke unit’s step down developed and implemented a protocol in which the expert stroke nurses respond to stroke STAT calls throughout the hospital. Outcomes of this project were positive by reducing the time from call to CT and call to treatment which can result in significant and robust health benefits over patients’ lifetimes.

Continuous Quality Improvement (CQI) Initiatives

Analysis of Two-tiered Triage System for Ischemic Stroke and Factors Associated with Delay in Thrombolytic Treatment
Tapan Mehta, MD, Amre Nouh, MD, Mohammed Hussain, MD – Hartford Hospital, University of Connecticut; Dawn Beland, RN, Lincoln Abbott, MD, FACEP – Hartford Hospital
A two-tiered nursing triage system for acute stroke patients is utilized at our emergency department enabling time-sensitive treatment and appropriate resource allocation. We evaluated our triage model over the past 2 years to identify efficacy and any factors associated with delays to thrombolytic treatment. We found an on average 7 minute delay for receiving thrombolytic therapy inpatients where limb weakness or aphasia was not identified in triage. Initiatives to improve recognition of aphasia and subtle limb weakness will improve ED door-to-drug times in our stroke patients.

Does Hospital Participation in Telestroke Lead to Faster DTN for Stroke Patients?
Arianna Moreno, Lee Schwamm, MD, FAHA, Anand Viswanathan, MD, PhD, Cynthia Whitney, RN, BSN, Kori Sauser-Zachrison, MD – Massachusetts General Hospital; Khawja Saddiqui, MD – Baylor College of Medicine
There is variation between hospitals on performance on acute ischemic stroke (AIS) care delivery – some hospitals do well on door-to-needle (DTN) time for tissue plasminogen activator (tPA) delivery and others have substantial room for improvement. Telestroke programs can connect spoke hospitals with fewer resources to the support that they need to ideally care for AIS patients. The correlation between the duration of a hospital’s participation in the Partners Telestroke Network and patients’ DTN time for tPA delivery was explored to better understand the impact of the Telestroke program.

Improving Stroke Care Through the Development of Neuroscience Clinical Champions
Eileen Gallagher, MSN, RN, ACNS-BC, Alexandra O’Connor, MBA, BSN, RN, CMSRN – Kennedy Health
Patients experiencing a stroke while hospitalized may not receive the timely interventions necessary to stop the progression as quickly as those who arrive to the ED via EMS. The Neuroscience Champion group at this facility recognized a need to develop and implement a plan to improve the hospital’s overall stroke recognition and treatment process targeting the In-Patient Stroke population.

Reducing Door-to-Needle Times for Tissue Plasminogen Activator Administration in Acute Ischemic Stroke: Quality Improvement Initiative at a Low Volume Community Hospital
Corazon Paraso, MS-FNP, Musarat Shareeff, MD, Ferdinand DiBlasio, JR., MD – Huntington Hospital; Paul Wright, MD – Northwell Health System
Time-dependent benefits of intravenous tissue plasminogen activator (tPA) hinge on a recommended door-to-needle (DTN) time of 60-minute or less. Compliance requires rapid identification and administration of thrombolytic therapy in patients with acute ischemic stroke (AIS). Implementation of a Plan-Do-Study-Act (PDSA) improvement methodology facilitated quality improvement (QI) initiatives designed to improve compliance with a DTN time within the prescribed 60 minute window.

Notification & Response of EMS

EMS and ED Stroke Feedback Tool: Improving Metrics and Patient Outcome
Angelia F. Russell, RN, BSN, CEN, Matthew Tilem, MD, Barbara Voetsch, MD, PhD – Lahey Health and Medical Center; With special thanks to: Jayashri Srinivasan, MD, PhD, FRCP – Lahey Health and Medical Center
Stroke care begins in the field and emergency department (ED) triage with rapid recognition and activation of the emergency medical service (EMS) stroke alert and hospital’s brain attack systems. Prompt recognition is paramount in the treatment and survival of the stroke patient. We hypothesized that providing prompt feedback to EMS and ED on the stroke care may improve engagement in the stroke care process, improve EMS and hospital metrics and raise the hospital’s defect free care.

Improving EMS Data Quality: Massachusetts Paul Coverdell National Acute Stroke Program EMS Stroke Quality Improvement Collaborative Implementation of Stroke Variables in Data Reporting
Kshema Nagavedu, MPH, Ridgely Ficks, NREMT, Claudine DeJoie-Stanton, COTA, Joanne Carney LaBelle, RN, CPHQ, MS, HRM, Claudia Fitzgerald, MA, Rebecca Sullivan, MEd, Anita Christie, RN, CPHQ, Laura Nasuti, MPH, PhD – Massachusetts Department of Public Health
The Massachusetts Paul Coverdell National Acute Stroke Program EMS Stroke Quality Improvement Collaborative is working with Emergency Medical Service (EMS) agencies across the state to measure and improve care for patients with stroke, including the EMS to Emergency Department (ED) stroke pre notification process. A standardized stroke alert policy was approved by the MA Medical Services Committee in August 2013. The role of EMS to notify hospitals when a potential stroke patient is transported requires effective communication from EMS to ED providers. Beginning in August 2014 Massachusetts implemented optional stroke variables into the Massachusetts Ambulance Trip Record Information System (MATRIS) to aid the pre notification process.

The Neuro Transfer Process: Transforming JFK into a Receiving Facility
Mark Bober, BS, NRP, FP-C, Jamie Chebra, MS, CEM, NRP, Rich Schlosser, MICP, Audrey Arango, RN, BSN – JFK Neuroscience Institute
As the eighth Joint Commission designated Comprehensive Stroke Center in the country, JFK prides itself on its reputation for delivering exemplary stroke care to the residents of central New Jersey. But as a stand-alone community hospital, receiving critical neuro patients from other facilities provided a new challenge to our organization. By partnering closely with our hospital’s EMS system, the Neuroscience Institute was able to triple its transfer volume over a three year period from 2013-2015. This was accomplished through the launch of JFK’s first Specialty Care Transport Unit, and an EMS-based “one call” transfer center to simplify the process for spoke facilities. Through conversations with multidisciplinary stakeholders from other organizations, ease of transfer process and speed of transfer process were identified as key areas on which we could improve, and a target transfer time from first call to arrival at JFK was established. Through continuous quality improvement, JFK was able to increase its acute neuro transfers by 50% from 2013 to 2014, and 102% from 2014 to 2015, all while meeting target transfer metrics 91% of the time. Utilizing continuous innovation, interdepart­mental collaboration, and partnership, JFK strives to fulfill its mission of providing comprehensive stroke care to all patients in need, and as a valuable service to our regional partners in stroke care.

Subacute & Secondary Prevention for Stroke

An Exploratory Investigation of Cognitive Function, Health and Stroke Literacy, and Health-Promoting Behaviors Among Veterans with Stroke Risk Factors
Christine A. Ganzer, PhD, PMHNP – Hunter-Bellevue School of Nursing; Constance Uphold, PhD, ARNP-BC, FAAN – Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Geriatric Research Education Clinical Center & University of Florida
Modifiable health conditions such as Type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia are associated with poorer cognitive functioning and an increased risk of stroke. Few studies have focused on the role of cognitive function, specifically executive function (EF) and health literacy, stroke knowledge and health promoting behaviors among individuals with stroke risk factors. This pilot study was carried out at a Northeastern Veterans Affairs Medical Center.