The 5th Annual Northeast Cerebrovascular Consortium Summit’s Poster Presentations
Evaluating the Effectiveness of a Community Education Radio Campaign on Stroke Warning Signs and Symptoms
Meghan Grady, MPA – American Heart Association/American Stroke Association
Mass media and television campaigns have been credited with increasing public awareness and knowledge of stroke risk factors and warning signs. A paid radio advertising campaign was aired during American Stroke Month with the total net reach of 250,400 individuals. Get-With-The-Guidelines (GWTG) data was analyzed from Rhode Island hospitals to determine the effectiveness of the campaign.
NOTIFICATION AND RESPONSE OF EMS
Impact of a Regional Roll-out on Providers’ Knowledge of Acute Stroke Management
Jonnathan Busko, MD, MPH, EMT-P Eastern Maine Medical Center; Rick Petrie, EMT-P, Regional EMS Coordinator, Northeast Maine EMS, Kennebec Valley EMS; Paula Lowney, MSSM, BSN, RN Nurse Coordinator for Joint and Stroke Centers of Excellence, Eastern Maine Medical Center
Patients with acute ischemic stroke benefit from vertically integrated regional care plans. These plans must include the public, emergency medical services (EMS), local hospitals and regional stroke centers. All providers involved in the care must have an adequate personal knowledge base so as to perform the appropriate management. Maine EMS Region 4 and Eastern Maine Medical Center (the regional stroke center) developed a regional Acute Stroke Identifiction and Early Emergency Departement notification protocal that standardizes the EMS stroke screening and mandates pre-arrival notification of the emergency department immediately upon recognition of the stroke. The objective is to allow the ED to prepare before the patient arrival to minimize door to drug times. Phase one of the project was the delivery and measurment of efficacy of the educational roll out sessions at the largest EMS agencies and all 11 regional hospitals for EMS providers, emergency department clinicians, nurses and hospital administrators involved in stroke care.
ACUTE STROKE TREATMENT
Interventional Stroke Therapies in the Elderly: Are We Helping?
Neer Zeevi, MD – UConn Health Center; Nora S Lee, MD – Hartford Hospital; Ilene Staff, PHD – Hartford Hospital; Louise D McCullough MD, PHD – UConn Health Center
Endovascular therapies such as intra-arterial thrombolysis and mechanical clot retrieval for the treatment of acute ischemic stroke (AIS) are being increasingly used by stroke centers. We reviewed the safety and efficacy of endovascular
therapies in elderly patients.
Assessment of Cerebral Perfusion Pressure (CPP) and Intracranial Pressure (ICP) in Patients with Acute Intracerebral Hemorrhage (ICH) Receiving Aggressive Blood Pressure Management with Clevidipine: An
Carmelo Graffagnino, MD – Duke University Medical Center; Richard Riker, MD – Maine Medical Center; Sergio Bergese, MD – Ohio State University; Cherylee Chang, MD – The Queens Medical Center; Gwendolyn Lynch, MD – Cleveland Clinic Hospitals; Tamer Abdelhak, MD – Henry Ford Hospital; Gregory C. Williams, PhD – Research and Development, The Medicines Company
ACCELERATE, a single-arm, open-label study, evaluated aggressive blood pressure management in patients with acute intracerebral hemorrhage using clevidipine, an IV antihypertensive with a t1/2 of about 1 min that directly reduces systemic vascular resistance and is titratable to effect. In ACCELERATE patients requiring intracranial pressure monitoring
and receiving clevidipine, cerebral perfusion pressure was maintained in an optimal range. In spite of clevidipine being a potent vasodilator, we did not observe any meaningful increases or other changes in intracranial pressure.
Evaluating Rates of Recanalization and Outcomes in Patients Receiving Full Dose of IV tPA Followed by IA Thrombolytics Versus Followed by Mechanical Intervention
Ugo Paolucci, MD; Mohammad Moussavi, MD; Spozhmy Panezai, MD; Jawad F. Kirmani, MD; Martin Gizzi, MD, PhD, FAHA, NJ Neuroscience Institute at JFK Medical Center, Edison, New Jersey
Bridging of acute stroke IV tPA therapy to either IA or MT does not appear to produce significant differences in recanalization or outcome. This suggests a need for further studies to evaluate the risk and benefit of implementing multiple endovascular treatment modalities in one subject to optimize our specific endpoints.
National Institute of Health Stroke Scale (NIHSS) Compliance
Geraldine Vickers, RN, BSN, CEN, CPEN and Leslie VanDenburgh, RN, BS, CCRN
We conducted a quantatitive retrospective study on NIHSS compliance after certifying ED Nurses December 2009. To date, we are above national, state and local benchmarks for compliance with NIHSS on all stroke patients.
Financial Impact on Loss of Stroke Designation
Geraldine Vickers, RN, BSN, CEN,CPEN and Leslie VanDenburgh, RN, BS, CCRN
Our study investigated the cost to our hospital and affiliate rehab center if we were to lose our stroke designation. Substantial financial loss would be incurred as well as impacting services to our community.
SUBACUTE STROKE CARE AND SECONDARY PREVENTION FOR STROKE
Comparision of Hospital Arrival Between Initial and Recurrent Stroke Episodes
Mervat Hanna, MD; Isabel McFarlane,MD; Veronica Hunko, RN; Zaitoon Memon, MD; Helen Valsamis, MD – Kings County Hospital Center
We assessed the hospital arrival time of stroke patients as initial presentation and compared it to the arrival in recurrent stroke cases. We found no improvement on arrival time for recurrent stroke cases. Further community education is needed.
Are Stroke Patients Being Assessed for Rehabilitation in the Acute Hospital?
J. Prvu Bettger, ScD, FAHA, Duke University, Durham, NC; J. Stein, MD, Columbia University, New York, New York; Z. Magdon-Ismail – American Heart Association Founders Affiliate
The NECC Rehab Subgroup surveyed hospitals in the NECC region to determine the proportion of stroke registry hospitals meeting the clinical guideline and quality of care performance indicator for conducting a standardized assessment for rehabilitation. Through the survey we explored what standardized measures are used by those hospitals in compliance. This
poster summarizes the findings.
Under-Identification of Spatial Neglect
Peii Chen, PhD – Kessler Foundation Research Center (KFRC); Pasquale G. Frisina, PhD – Kessler Institute for Rehabilitation (KIR); Anna M. Barrett, MD – KFRC, KIR
Spatial neglect is a common, disabling poststroke neurocognitive disorder (30-70%acute prevalence). However, spatial neglect is frequently undetected clinically. The ICD-9-CM spatial neglect code is barely used administratively. This study raises a serious concern about the validity of cognitive stroke outcomes research using clinical documents or secondary data.
CONTINUOUS QUALITY IMPROVEMENT (CQI) INITIATIVES
Improving Outcomes for Ischemic Stroke Patients at North Shore-LIJ Health System
Kenneth J. Abrams,MD, MBA – North Shore-LIJ Health System; Richard B. Libman, MD FRCP(C) – Long Island Jewish Hospital; Karen Nelson, RN, North Shore-LIJ Health System; Susan Delosh, RN, North Shore-LIJ Health System
Through adherence to evidence-based guidelines and establishing interfacility transfer protocols for patients requiring a higher level of care the North Shore-LIJ Health System has improved the timely administration of t-PA and patient outcomes. A Systemwide Stroke Rescue Program was developed to ensure timely transfer of patients and measures of timeliness
of transport have been developed to identify existing gaps in transfer of patients.
The Successful Implementation of a Collaborative, Interdisciplinary, CMS Structural Quality Measure-Compliant Stroke Data Collection, Review and Reporting Process at an Urban Academic Medical Center and its Urban Community Hospital Affiliate
Emily Schaab, MS, ANP-BC, GNP-BC, RN, CEN, CNRN – Mount Sinai Hospital, New York, NY, and Mount Sinai Hospital of Queens, Long Island City, NY; Stanley Tuhrim, MD – Mount Sinai School of Medicine, New York, NY; Lori Finkelstein-Blond,
RN, MA, CIC – Mount Sinai Hospital, New York, NY; Lourdes S. Geslani, BSN, RN, CPHQ – Mount Sinai Hospital of Queens, Long Island City, NY; Sonia D. Nelson, RN, MSN/M – Mount Sinai Hospital, New York, NY; Susan Nevins, RN, MA, CNRN, CCRN, ACNP/NP; Preetham Bilumane – Mount Sinai Hospital, New York, NY; Venkateswara Manam – Mount Sinai Hospital, New York, NY; Barbara Callas, RN – Mount Sinai Hospital, New York, NY; Andrea C. Salesman, MBA, MSN, RN – Mount Sinai Hospital of Queens, Long Island City, NY; on behalf of the entire Mount Sinai / Get With the Guidelines-Stroke implementation team
On January 1, 2010, in response to the Centers for Medicare & Medicaid Services Structural Quality Measure for Fiscal Year 2011 Payment Determination, our stroke center teams from our urban academic medical center and our urban community hospital affiliate successfully implemented a stroke data collection, review and reporting process utilizing the Get With the Guidelines®-Stroke (GWTG-Stroke) registry. This collaborative, interdisciplinary, bicampus process, coordinated by our Stroke Center Coordinator, has involved our neuroscience clinical nursing staff, stroke fellows and attending physicians, quality assessment staff, and information technology staff in the development of systems that enable us to maintain both an internal data repository and the capability to upload data to GWTG-Stroke for reporting to The Joint Commission and the New York State Department of Health. The integration of concurrent data collection using our electronic stroke physician documentation tool and our online stroke nursing data collection tool engages our front-line clinicians in the performance improvement process at the point of care. Our stroke center coordinator monitors compliance in real time and she and our quality research analyst staff retrospectively abstract data and quality control all concurrently collected data prior to upload to GWTG-Stroke. Continuing to support and sustain these well established systems and processes has enabled us to enhance our ability to assess clinical performance and quality of care, and to identify opportunities for improvement across campuses.
The Devil’s in the Details: Optimizing Outcomes by Minimizing CT Time in a Community Hospital
Cindy Spencer, BS, RN, CCRN – Wentworth Douglass Hospital; Nicole Connors, RN, BSN – Wentworth Douglass Hospital
In community hospitals, intravenous rt-PA is often our only on-site treatment for acute ischemic stroke, requiring coordination of many activities (CT, lab, and other diagnostics) during the “golden hour” of emergency management. Complying with turnaround time (TAT) metrics established by the American Heart Association and The Joint Commission is particularly
challenging in that we typically have more limited staff, equipment, and experience. Our NH hospital saw dramatic improvement — from baseline, compliance improved 108% and TAT by 84%–in CT TAT by capitalizing on existing
resources and utilizing detailed data from a simple tracking tool.
The Impact of Brain Asymmetry on Post-Stroke Infection Frequency
Pasquale G. Frisina –The Kessler Institute for Rehabilitation, NJ USA; Anna M. Barrett – Kessler Foundation Research Center, NJ USA; Peii Chen – Kessler Foundation Research Center, NJ USA; Ann M. Kutlik – Kessler Institute for
Rehabilitation, NJ USA
The present study examined the relationship between stroke lateralization and infection rates. A retrospective analysis was performed (January 2009-July 2010) on electronic medical records from the Kessler Institute for Rehabilitation. The
prevalence of infection was significantly higher in left-sided (60%) than right-sided (40%) stroke patients, chi-square(1) = 4.28, p < .05. Findings from our study are consistent with the hypothesis that the brain may modulate the immune system through a left-dominant brain immune network (LD-BIN). Clinical implications relate to a greater identification of stroke patients that are at most risk for infection—namely, those with left-sided brain lesions. Stroke Care in Maine — Analysis of All-Payer Claims Data to Measure Stroke Quality of Care Danielle Louder – Maine CDC/DHHS Cardiovascular Health Program; Robert Keith – University of Southern Maine; Robert Stein, MD – Penobscot Bay Medical Center; Rita Zanichkowsky – American Stroke Association, Founders Affiliate Ongoing analysis of stroke care data is vital to improving quality and outcomes. However, few of Maine’s 36 acute care hospitals currently collect such data, either as Joint Commission Primary Stroke Centers, or as GWTG-Stroke hospitals. The Stroke Care in Maine Workgroup conducted an analysis to assess the feasibility of using medical claims data to measure quality of care for individuals hospitalized for stroke, and to utilize the data to establish state-wide baselines for quality metrics. Feasibility of a Novel Stroke Support Group Model Alexandra DeSorbo, MPH – Harlem Hospital Center; Hazella Rollins-LaVar – Stroke of Hope Foundation; Olajide Williams, MD, MS – Columbia University Medical Center The Hope Stroke Support Group at Harlem Hospital in New York City aims to improve the quality of post-stroke life of survivors and their families through a unique model in which formal support group intervention begins on the first day of the acute hospitalization. Forty percent of stroke patients engaged by Hope team members during the acute stroke hospitalization participated in at least two support group meetings following discharge. We find that integration of a stroke support group protocol into the acute stroke hospitalization is feasible. A Guideline for Acute Stroke: An Evaluation of New Jersey’s Current Practices Erica Frangione, DNP, RN-BC – Bayonne Medical Center, Bayonne, NJ Lack of adherence to the established guidelines for care of the acute stroke patient may significantly affect the outcomes of care. There is a lack of literature on the statewide guideline compliance for acute stroke. Evaluation and diagnosis according to guidelines will yield and direct the stroke healthcare professional to the appropriate treatment options and level of care required for the acute ischemic stroke patient. This is a descriptive study utilizing an electronic survey developed by the researcher for stroke health care professionals practicing in New Jersey acute care hospitals. The purpose of this study was to determine the effectiveness of the processes and guidelines for the acute stroke patient receiving care in New Jersey acute care hospitals (Primary, Comprehensive or no Stroke Center designation). The Impact of Concurrent Review on Stroke Center Measures at The Miriam Hospital Celia Gomes McGillivray, MPH,BSN,RN,CHES, The Miriam Hospital; Jason T. Machan, Ph.D., Rhode Island Hospital Little research has been published about which interventions impact practice patterns such that quality measures have been impacted. Evidence is presented in support of concurrent review in stroke patient management by comparing overall performance over time on quality indicators for The Miriam Hospital (TMH), a Joint Commission certified hospital as a primary stroke center. TMH tracks a number of indices, one was called the composite index. The study demonstrated the impact of concurrent review on stroke center measures. The NECC would like to offer strategies for success for 2011. NECC will help mentor your project by reviewing the hypothesis and design before you implement! This can help ensure your research design is solid before you start! Send your draft research design to [email protected] to be reviewed. Please allow a minimum of 2 weeks for review. You will be paired up with one of our mentors that can review and provide technical assistance. If you are interested in serving as a mentor please contact Shannon Melluzzo at (413) 735-2104 or [email protected]