Summit 2009 Posters

The NECC 4th Annual Summit Poster Presentations
Health Promotion and Community Education

Addressing Disparate Populations Using a Culturally Adapted Media Campaign:
¿Será que es un STROKE?
Katrina D’Amore, MPH; June O’Neill, MPH; Kathleen M Foell, RD, MS
MA Department of Public Health

One in four people recognize all signs of a stroke. Because of this, the Heart Disease and Stroke Prevention and Control Program (HSPC), has developed a comprehensive public education campaign on stroke in English, Spanish and Portuguese. The Stroke Heroes Act FAST campaign educates the public about the signs of stroke and stresses the need for action.

Retention of Stroke Knowledge Following a Community Stroke Education Program

Casey Leber RN, BSN, Winchester Home Care; Janine Jones RN, BA, Winchester Hospital

The purpose of this study is to educate the community regarding the signs and symptoms of a stroke and to assess the retention of this knowledge. Stroke is the third leading cause of death not only in the United States, but also in Massachusetts. The American Heart Association (AHA) and the American Stroke Association (ASA) have started national campaigns — Give Me 5 for Stroke and F*A*S*T— which are intended to educate the public about recognizing the signs and symptoms of stroke. The only way to inform the public about the severity of stroke is through education. The only way to ensure that the education is effective is by testing the retention of the knowledge gained.

Notification and Response of EMS

EMS Education for Stroke Designation — Collaborating for Success in the Capital Region

Christine Ball, MS, RN, Northeast Health; Tiana Howland, RN, New York State; Department of Health, Healthy Heart Program; Mary Madison, RNC, CCM, BSN, Seton Health; Nancy Newkirk, MS, RPh, St. Peter’s Hospital; Kate Radler, RN, Albany Medical Center

In the Capital Region of New York state six area Designated Stroke Centers (DSC), AHA, and New York state Departmnet of Health (DOH) collaborated in designing and hosting a joint EMS training on stroke. New York State DOH gave prior approval for the collaborative to meet one of the two EMS education requirements for each of the DSC. This project demonstrates how collaboration between stroke centers around EMS education can be done to decrease cost, time, and resources used.

Acute Stroke Treatment

Adjunctive Endovascular Thrombolysis After Full Dose Intravenous Thrombolysis is Safe

Nazli Janjua, MD – Department of Neurology, Long Island College Hospital; Rebecca Poleshuck, NP – Department of Neurology, Long Island College Hospital; Ximena Morales, MD – Department of Neurology, Long Island College Hospital; Toby Gropen, MD, FAHA – Department of Neurology, Long Island College Hospital

IV tPA at a dose of 0.9 mg/kg is the current standard of care for fitting patient with acute ischemic stroke. In cases of suspected large artery occlusion, there is anecdotal data that IV tPA may be less effective than endovascular therapy. However, the safety of full dose IV tPA followed by additional IA tPA is unknown. We sought to evaluate its safety in this retrospective analysis.

Enhancing Telehealth Systems to Increase Access and Improve Stroke Outcomes in Maine

Danielle Louder, CVH Specialist – Maine CDC Cardiovascular Health Program; Barbara Grillo, Director – Neuroscience Institute, Maine Medical Center; John Belden, MD – Medical Director, Maine Medical Center Stroke Program; Steve Diaz, MD, FACEP – Vice President Medical Administration, MaineGeneral Medical Center; Scott Kemmerer, MD, FACEP – ED Medical Director, MaineGeneral Medical Center; Scott Shulman, MD – Medical Director, MaineGeneral Medical Center Stroke Program; Rita Zanichkowsky, Director – State Health Alliances, AHA/ASA

The focus of this project was to determine whether enhancement of existing telehealth systems between two Maine hospitals would increase access and delivery of evidence-based care for stroke patients in Maine. Increased utilization of thrombolytics among eligible patients, and increased confidence in using telehealth to diagnose and treat acute stroke among providers at both hub and spoke sites were documented outcomes. Replication of this model to achieve statewide 24/7 neurology consultation coverage is already underway.

Stroke System Development Through Policy: The Stroke Prevention and Treatment Act of 2009 (RIGL 23-78.1)

Peter Panagos, MD, Rhode Island Stroke Task Force; Megan Tucker, American Heart Association;Meghan Grady, MPA, American Heart Association; Pat Affleck, MSM, RI Department of Health

The Stroke Prevention and Treatment Act of 2009 was unanimously approved by the House and Senate and signed into law by Governor Donald Carcieri. The American Heart Association, Department of Health, Stroke Task Force and legislative champions worked together to craft and promote the Stroke Prevention and Treatment Act of 2009. The legislation — based on AHA/ASA science and guidelines — reflected years of collaboration around the table with this core group of partners.

Will a Documentation Tool with Clear Visual Cues Improve Consistency, Accessibility and Clarity in Nursing Neurological Documentation in Ischemic Stroke Patients who are Treated with Alteplase

Susan Moore, BSN, RN, Kent Hospital; Kathleen Bergeron, MSN, RN, CEN, Kent Hospital

Clear visual cues improve consistency, accessibility and clarity in the documentation of neurological assessments in ischemic stroke patients treated with alteplase.

Subacute and Secondary Prevention for Stroke

Assessment of patient compliance with secondary stroke prevention measures

Angela Mccall-Brown, MSN, Overlook Hospital; Bela Laschiver, APN-C, Overlook Hospital

We assessed compliance of patients with secondary stroke prevention measures after discharge from the hospital. A significant number of patients did not comply with the antiplatelet drug regimens or smoking cessation guidelines. Blood pressure control was suboptimal. Continued medical follow up and education are necessary after a stroke to ensure institution of optimal secondary prevention measures.

It Takes a Village… Engaging the Stroke Community to Develop Excellent Patient Education Materials

Richard Veilleux, MPH, MBA — MaineHealth

Stroke patients and their families face many challenges after a stroke and healthcare providers struggle to provide information to address these challenges. To address this issue the MaineHealth Stroke Workgroup identified the priority need for concise, relevant educational materials to help patients and families meet those challenges and improve their outcomes. MaineHealth addressed this priority by engaging patients, families and providers in a collaborative process to develop educational tools specifically targeted to this population.


Clinical Research — Clinical Care (CRCC) Spatial Neglect Partnership Program

Barrett, Anna M. – Kessler Foundation, Kessler Institute of Rehabilitation; Fortis, Paola – University of Milan, Bicocca; Goedert, Kelly M. – Seton Hall University; Eller, Monika – Kessler Institute of Rehabilitation; Hedeman, Robin – Kessler Institute of Rehabilitation; Masmela, Jenny R – Kessler Foundation Research Center; McKenna, Cristin – Kessler Foundation, Kessler Institute of Rehabilitation; Chen, Peii – Kessler Foundation Research Center; Carolan Terrence C. – Kessler Institute of Rehabilitation; Hreha, Kimberly – Kessler Institute of Rehabilitation; Zaidi, Naureen – Kessler Foundation Research Center; Pigott, Kara – Kessler Foundation Research Center; Frisina, Pasquale – Kessler Institute of Rehabilitation

After a recent Cochrane review (Bowen & Lincoln, 2007) called for improved functional-based assessment in spatial neglect therapy and research, the Kessler Institute of Rehabilitation partnered with the Kessler Foundation Research Center to improve neglect assessment and care planning as well as collect research treatment outcomes. We wished to assess spatial functional improvement using the Catherine Bergego Scale in stroke survivors enrolled in a pilot prism adaptation spatial neglect therapy research program. Scores on the CNS improved in the nine pilot program participants. The CRCC partnership demonstrated feasibility of developing a therapistresearcher team for visual-spatial functional performance measures and spatial neglect research treatment. This may result in improved practice expertise as well as research knowledge.

Improving Functional Recovery in Medically Complex Stroke Patients: Preliminary Outcomes from a Highly-Specialized Acute Inpatient Stroke Rehabilitation Program

Pasquale G. Frisina, PhD – The Kessler Institute for Rehabilitation, New Jersey USA; Uri S. Adler, MD – The Kessler Institute for Rehabilitation, New Jersey USA; Lauren McDonagh, PT – The Kessler Institute for Rehabilitation, New Jersey USA; Loran Vocaturo, EdD, ABPP – The Kessler Institute for Rehabilitation, New Jersey USA; Anna M. Barrett, MD – The Kessler Foundation Research Center and UMDNJ – NJMS, New Jersey USA

The Kessler Institute developed the Medically Complex Stroke Rehabilitation Program (MCSRP) to provide an optimal interdisciplinary recovery pathway targeting patients with severe functional deficits. We seek to learn whether an initial MCSRP patient group (N = 15) improved in functional independence during acute rehabilitation in our program. Indeed, severely disabled stroke patients evidenced significant improvements in functional outcomes from MCSRP.

Predicting Discharge Destination of Stroke Patients in Acute Care Using the AlphaFIM Instrument

Gary Stillman, MS, OTR, Kaleida Health, Buffalo, NY; Paulette Niewczyk, MPH, PhD, Uniform Data Systems for Medical Rehabilitation, Buffalo, NY; Carl V. Granger, MD, Uniform Data Systems for Medical Rehabilitation, Buffalo, NY

The limited resources available to an increased number of patients has necessitated the development of accurate predictive instruments to provide objective data to aid in appropriate discharge plans from the acute care hospital. Little research has focused on the validation of instruments used in acute care for the stroke patient at a time of increasing pressure to justify patient access to costly post-acute care services. The AlphaFIM instrument is a validated, quick and easy to administer instrument used in the acute care hospital to aid in post-acute care discharge planning for stroke patients.

The Relationship of Physical Function to Social Integration Following Stroke

Susan Baseman, DrNP, APRN – Cooper University Hospital; Kathleen Fisher, PhD, CRNP – Drexel University

Research on stroke rehabilitation has focused on physical functional recovery as the predominant measure of outcome. Despite increasing emphasis in post-stroke rehabilitation guidelines and evidence-based standards of care on the psycho-social impact of stroke on the patient and family, there is a gap in knowledge with regard to social issues and integration into societal, family, and community roles post-stroke. This study examined the relationship between stroke survivors’ social integration and changes in physical functioning. The goal is to improve understanding of stroke survivors’ rehabilitation needs relative to social integration.

Continuous Quality Improvement (CQI) Initiatives

Delays in MR Imaging in Acute Stroke: Using Process Mapping of a Microsystem to Identify Causes and Potential Solutions

Tracie Caller, MD, DHMC; Timothy Lukovits, MD, DHMC

Current evidence-based guidelines suggest that magnetic resonance imaging (MRI) is the most accurate method for determining if an acute ischemic stroke is present. Stroke patients at DHMC can experience delays to MRI. More than a 24 hour delay was associated with a longer length of stay, which can cause delays in providing appropriate therapy. Recommendations to our microsystem include streamlining the process of communicating MRI orders to the radiology department and standardizing the triage of MRI orders to make wait times more predictable.

Developing and Maintaining a Primary Stroke Center Designation Program: The New York State Experience

Anna Colello, Esq; Francia Salcedo, MD; Steven Jarrett, MD; Gregory Young, MD; John Morley, MD, The New York State Department of Health, Office of Health Systems Management

Designation of primary stroke centers in New York State began in 2005. To date 116 hospitals have been designated. The following poster describes the criteria, methodology and model used to designate and continuously monitor designated stroke centers. Annual audit findings as well as preliminary data on stroke process measures using state data will also be shown.

Developing a SCORE website and Quality Improvement Tracking Database

Laura Coe, MPH – MA Department of Public Health

The Stroke Collaborative Reaching for Excellence (SCORE) is a quality improvement (QI) collaborative of 56 Massachusetts hospitals. To address a need in 2007, SCORE applied for minigrant funds for: 1) the creation of a website that provides general information to the public and serves as a repository for resources for SCORE hospitals and 2) a QI tracking database for staff to document interactions with sites.

Great Lakes Regional Stroke Network: Improving Quality of Stroke Care

Angela Bray Hedworth, MS, RHEd, CHES – Great Lakes Regional Stroke Network

The Great Lakes Regional Stroke Network has reached over 3500 healthcare professionals with quality improvement teleconferences. 41–76% of participants plan to make changes in their process based on information learned in these teleconferences.

Great Lakes Regional Stroke Network: Swallow Screening Project

Angela Bray Hedworth, MS, RHEd, CHES – Great Lakes Regional Stroke Network

Data from the Paul Coverdell National Acute Stroke Registry programs in the Great Lakes Region showed dysphagia screening prior to any oral intake as one of the three lowest quality indicators. A subcommittee was formed of speech language pathologists and nurses from the hospitals of varying sizes, credentials, and locations. All swallow screens in use by these institutions were presented and reviewed. A literature review was conducted identifying swallow screens that had been tested for reliability and validity.

Improvement of Stroke Care in a Multi-Hospital System (MHS) using Six Sigma Methodologies

Joseph G. Conte, MPA – Catholic Health Services of Long Island; Joel Yohai, MD – Catholic Health Services of Long Island; Mary L. Marino, MA – Catholic Health Services of Long Island; Joseph N. Marcone, MS, CSSBB – Catholic Health Services of Long Island

The objective of this study was to improve performance in stroke care at our multi-hospital system. We combined the principles of the Six Sigma methodology with our traditional Continuous Quality Management approach to assess its utility in the clinical setting. The results after the pilot period were dramatic, there was a statistically significant increase over baseline in the defect-free scores (Chi Square, p<0.001) as well our performance exceeded US and NYS GWTG benchmarks (Chi Square, p<0.001). While Six Sigma is relatively new phenomenon in healthcare this study has shown that it can be a powerful tool to improve patient care. Teaming up for Action: Developing a Comprehensive Stroke Program Across a Large and Diverse Health System Richard Libman, MD, Long Island Jewish Medical Center; Kenneth Abrams, MD, North Shore-LIJHS; Karen Nelson, RN, North Shore-LIJHS; Lori Stier, RN EdD, North Shore-LIJHS; Susan Delosh, RN, North Shore-LIJHS The need to improve care provided to patients suffering from a stroke was deemed a priority by our Senior Leadership and Board of Trustees. The challenge was to come to agreement on a uniform standard of care for the patients, families and diverse communities we serve and implement it across multiple tertiary and community hospitals with varying resources. A system wide Stroke Task Force provided direction, structure for communication and a forum for reaching consensus. Standardizing care at the bedside, keeping practitioners engaged through communication, placing accountability at the hospital level and a strong commitment from Senior Leadership reduced variation, improved patient outcomes and sustained performance. The Rhode Island Stroke Network — Increasing Collaboration, Communication, and Community among Stroke Coordinators Meghan Grady, MPA - American Heart Association/American Stroke Association; Christine Kearns, MS, CNRN, FNP-BC, Rhode Island Hospital The Rhode Island Stroke Coordinators Network was established in December 2008. Participation was open to acute care hospitals and public health partners. In July 2009, the Network conducted a survey to measure the satisfaction of its membership after 6 months involvement and determine the future direction of the group. 76% of those who responded to the survey classified their experience as excellent or good whereas only 24% described their experience as fair.