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Cedars-Sinai Medical Center

By Taryn Fort

Part Three: The Core Team (Read More: Parts 1 & 2, Parts 5 & 6)

The Joint Commission requires at least eighty percent of emergency department staff understand the organization’s stroke protocol. Additionally, any staff, including neurology and critical care staff, step-down staff and any other departments providing direct care to stroke patients must receive education. Nurses not working within the stroke unit and housekeeping staff must understand stroke symptoms and know how to activate the emergency response team. As months went by, educational and communications strategies were implemented throughout the hospital. Efforts to collect and analyze data were launched.

Paletz was responsible for creating and implementing every education program throughout the effort. “She personally educated nearly every stroke patient, reached out to the community, educated the hospital staff and oversaw data collection,” said Palestrant. Working with nearly every department in the medical center, the core stroke team took on the enormous task of ensuring every stroke patient was and continues to be quickly navigated through the acute stroke pathway.

The core team, according to Paletz, made everything possible. Each member has detailed responsibilities from educating specific departments to devising and managing new systems of care.

The team’s manager, Pamela Roberts, PhD, happened to be a long-time Cedars-Sinai employee with data expertise. “She really worked side by side with us to make sure every single detail was addressed,” said Paletz. “Her relationships with colleagues in her over 20 years at this medical center served us well.”

Patient, family and staff education was managed by nurse practitioner, Leslie Tarlow, RN, MSN, MSCN, GNP-BC, who continues stroke education today. “The patients have repeatedly acknowledged the individual and class education that we provide as being extremely helpful to them and to their families in relieving their fears, providing hope for the future and offering beneficial strategies for their rehabilitation and transition home,” commented Ms Tarlow.

Pharmacist Amanda Lamer “tirelessly” set-up and managed all educational pharmacy policies and systems related to stroke to ensure hospital pharmacists understood the use of the clot-buster drug, t-PA, and other stroke-related medications.

All nurse staff education, inservicing and certification requirements were fulfilled by stroke unit nurse manager Andrew Baxter. Today, “every nurse on the stroke unit is NIH stroke scale certified and telemetry trained” Paletz said. 

When it came time for data collection and presentation, Paletz praises data coordinator Sonia Guerra -- she “was truly the one who helped put together the joint commission application.”

Part 4: Next Steps: Communications and Marketing

All education must be documented for certification, so the stroke team created a communications plan targeting the 10,000 employees of Cedars-Sinai. Within four to six months, the team managed to conceptualize, design, gain internal approvals and manufacture the necessary components of what would eventually be a multi-pronged educational effort. Employee badge cards featuring stroke signs and symptoms and how to activate our ‘Code Brain’ acute stroke pathway were developed in 2007. “It worked well,” said Paletz. “We attached them to the paychecks so every employee received one. We also spoke to the volunteers in and around the hospital so they had them as well. All new employees receive them in orientation.”  A larger effort, including signs, tables, displays, giveaways, and inservices, unfolded in the summer of 2008, just before certification. “We worked hard to go to all manager meetings, staff meetings and pretty much any meeting we could get on the agenda just to talk up the stroke program, the upcoming survey and just to make sure every area of the hospital was knowledgeable and prepared. We had signs all over the medical center and parking lots areas,” she said.

Staying on Track
As survey time neared in early summer 2008, the stroke team joined National Stroke Association’s Stroke Center Network (SCN) a membership program designed specifically for stroke teams dedicated to advancing stroke care at their facilities. Paletz labored through tough days of questioning the team’s moves and searching for new strategies to educate and communicate. “It is not an easy task to coordinate the efforts for The Joint Commission stroke certification,” she said. “But then . . . nothing worthwhile ever comes easily.”

She found many answers by networking online with colleagues and sharing strategies through National Stroke Association’s SCN message board. “Even at times of great frustration or what seemed to be insurmountable hurdles it really helped to bounce things off a colleague who has been there and could totally understand the situation and offer workable suggestions,” she said. “The SCN network was a wonderful resource. I was able to network and connect with colleagues in various stages of the certification process. They were able to provide me with sample questions the surveyor might ask, samples of their systems, and order sets. I was able to share things with the staff that I would never have known otherwise.”

Certification requires a stroke program to facilitate and maintain a community partnership with local EMS. The program is responsible for training EMS about hospital stroke protocol, so Los Angeles County EMS became a major focal point.

“EMS is a very important part of our stroke program,” Paletz said. So important, she said, they were actually present for The Joint Commission survey that eventually led to certification. Paletz also collaborated with the team’s nurse practitioner to develop competencies for stroke patients in the medical center. “Leslie and I spent many hours educating our staff to be competent in their stroke knowledge and care of stroke patients.”

Paletz counts a “very close relationship with” the inpatient rehabilitation unit as a plus for improving patient outcomes due to the seamless continuum of care. “We can easily move appropriate patients into rehabilitation quickly,” she said.

No department within the hospital was left behind. “We met and worked closely with the emergency department, who were amazing and more than willing to get involved and work with us,” said Paletz. “The physicians, nurse manager and nursing staff are such an integral part of the success of our orders, pathways and procedures. The radiology physicians and staff were on board and happy to work hard to meet the required timelines. [They were] often ready and waiting for the acute stroke patient when they get word the patient is on the way. The laboratory staff worked hard to expedite lab work, even dedicating an i-stat machine for our stroke patients in an effort to expedite the BUN & creatinine results to expedite the CT perfusion studies. The ICU staff were trained and ready to receive post t-PA patients or hemorrhagic stroke patients.” 

Read More: Parts 1 & 2, Parts 5 & 6

Find out more about National Stroke Association’s Stroke Center Network (SCN) program!

Questions about SCN can be directed to pmembers@stroke.org or 303.754.0935.

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info@stroke.org