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Improving In-Hospital Stroke Response: A Team-based Quality Improvement Program

A National Stroke Association Pilot Program

In-Hospital Stroke Facts

  • Mortality is two to three times higher for in-hospital strokes.
  • Studies consistently demonstrate greater in-hospital delays on evaluation for stroke with onset in the hospital; only 15% of in-hospital strokes are evaluated by a physician within 3 hours of symptoms.
  • In-hospital stroke patients are half as likely to return home.

The Program

In 2010, National Stroke Association selected seven Stroke Center Network SM member hospitals to participate in the 18-month pilot program that included a multi-tiered approach to educating hospital staff on the issues surrounding in-hospital stroke.

The purpose of the program was to improve hospital processes, reduce time-to-treatment and improve patient outcomes for in-hospital stroke. Despite the availability of on-site hospital resources, reports showed that between 4 and 17% (31,000 to 134,000) of strokes each year occurred in patients who were already in the hospital for other reasons.

The objectives of the program were also supported by research pointing to times-to-treatment for in-hospital strokes being significantly longer compared with strokes that occurred outside of the hospital. Unfortunately, research also pointed to patient morbidity and mortality being also worse for in-hospital strokes. Through multiple educational tactics, including grand rounds, Lunch-n-Learns and Web resources, the program provided hospital teams with strategies, tools and support to improve patient care and raise awareness of in-hospital stroke.

Program Components
National Stroke Association provided a multi-tiered approach to educating hospital staff on the issues surrounding in-hospital stroke:

In-Hospital Stroke Resource Center
Access recent peer-reviewed articles, presentations and tools hospitals can use to enhance their own quality improvement project.

Improving In-Hospital Stroke through QI Interventions Webinar
Learn how quality processes have improved in-hospital stroke care metrics and about successful intervention models, tools, and processes that they can apply in their respective situations.

Optimizing Our Response to In-Hospital Stroke Grand Rounds **
This grand rounds series, developed by experts Ethan Cumbler, MD, and Soojin Park, MD, takes a case-based approach in educating hospital staff on the impact of in-hospital stroke, the causes of and where in the hospital they most likely occur and current treatment options.

Non-medical Staff Lunch-n-Learn Activities **
Stroke center staff can educate the entire hospital staff on the signs and symptoms of stroke and what protocols the hospital has in place when signaling a stroke alert.

Peer coaching ***
Allows participating pilot sites the opportunity to learn from colleagues nationwide about successes and challenges in conducting the quality improvement project.

Disclaimer: ** Certain activities listed above were only available to the participating sites during the 2010-2011 pilot program.

The educational program was sponsored by an educational grant from Genentech, Inc. and support from Penumbra, Inc.


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