Remote Treatment Stroke
Center Designation
The Why and How to
May 14, 2015
Presenter’s Disclosures
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McCord Smith, MD – none
Beth Watkins, RN – none
James Lugtu, RN, NP – none
David Briscoe, EMT-P – none
Debbie Camp, RN
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Genentech Speaker’s Bureau
Coverdell Steering Committee member
Georgia- Stroke Professional Alliance- Past Chair
Tenet Stroke Collaborative- Past Chair
ASLS Instructor Trainer
• Shelley Nichols, RN – none
Commitment
• At the top
• Strategic plan
• Every level
• Budget, time & personnel
• Consistent
Organization
• Physician champion
• Stroke Coordinator
• Stroke Committee
• Core Stroke Team
• Link to “hub”
• Quality Department
• Protocols
Collaboration
• Internal
• Designated point person
• Radiology
• Pharmacy
• Physical Therapy
• Quality
• Abstractor(s)
• ED physicians/staff
• Hospitalists
• Cardiology
Collaboration
• External
• Georgia Coverdell Acute Stroke Registry
• American Heart Association
• Georgia Department of Public Health
• Georgia Office of EMS
• Georgia Hospital Association
• Georgia Stroke Professional Alliance
• The Joint Commission
• Vendors
Education
• Staff
• Physicians
• EMS
• Community
• Awareness
• Prevention
Help
• Coverdell
• GA-SPA
• AHA/ASA
• NSA
• Primary Stroke Center
• Comprehensive Stroke Center
Build the process
• Coverdell Registry/data
• Abstractor selection and training
• Telemedicine
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Establishing a project plan
Physician credentialing
Physical infrastructure
Grants
Benefits of Coverdell Registry
• Monthly registry-wide telephone conference calls with participating
hospitals, EMS agencies and GCASR staff
• “Kickoff” workshop for new participants
• Annual regional data abstraction training workshops
• Quarterly GCASR newsletters
• Annual meetings to exchange best practices
• Quality improvement consultant to work with hospital staff on-site
or by telephone
• Encouragement to hospitals to network with one another
• Great resources and mentoring for hospitals needing specific stroke
related information
• Georgia Coverdell Champion Hospital of the Year Awards
• Opportunity to contribute to improve stroke care quality statewide
Education
• Staff & Local EMS providers
• ASLS
• Targeted in-services
• Transfer process (Coverdell transfer form)
• Receiving hospital process
• Mock drills
• Continued support
• Community
• Health fairs
• Industry
• Schools
• Churches
Prepare for the Visit
Develop Checklist
Letter of Intent as remote stroke treatment center from
hospital CEO
Appoint Medical Director for stroke program
Prepare protocols (preprinted and electronic)
Prepare pre-written stroke order set in collaboration with Hub
Hospital
Write policy on stroke notification system, with expected
response times
Develop transfer protocol
Work with other departments (Lab, Radiology) to prepare
protocols
• Mock drills
Continue the plan
• EMS feedback form (Coverdell) (need to add
form)
• Hospital internal feedback
• Marketing
Building Relationships
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Sharing dashboards/data
EMS workroom
EMS banquet
EMS to stroke committee meeting
“Thank you” for caring for our patient/for bringing the patient to
us
Straight to CT scan
Talk about an interesting patient
Grand rounds correlate symptoms to scan
Physician involvement
Ask questions to encourage
Collaboration and collegiality
Identifying stroke save
Certificate of appreciation “great job” in the field
Building Relationships
• Learn names
• Report directly to neurologist
• Use the medics to teach
• ASLS with nurses and medics
• Physical presence in the ED and on the nursing unit
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EMS Provider: National EMS
Date: 05/20/2014
Crew: Eddie Dixson & Kelly Glover
On Scene to Transport Time: 15 min
CPSS, MEND EXAM, and Last Know Well documented by
EMS! Great Job – communication is key to excellent
stroke care!
ED Physician: Brandon Hicks, MD
Neurologist: McCord Smith, MD
ED RN: Casey Shields, RN
NCCU RN: Reghan Dagley, RN & Marie Saylor, RN
Last Known Well: 12:15
Arrived: 13:19
NIHSS on arrival: 6
Door to CT: 5 min
Door to Needle: 58 min
NIHSS at DC: 1
Patient was discharged home
EMS STROKE UPDATE
Maintaining the Momentum
Major responsibility of the Stroke Champions
Meeting and sustaining the requirements for
following evidenced based practices to improve
outcomes for patients entering their healthcare
facility.
Program Engagement Continues
• Success of the Stroke Program requires:
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Administrative buy-in
Stroke Medical Director
Stroke Coordinator
Interdisciplinary Team has Stroke Champions
Hub & Spoke Partnership
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Credentialing
Mentoring/Mock Drills
Policy/procedure updates
Commitment to Improving Outcomes
Trusting Collaborative Relationships
Exchanging Professional Experiences
Clinical Expertise / Evidenced Based Practice
BELIEF THAT YOU CAN & DO MAKE A DIFFERENCE
Collaboration Requires both Clear
Communication and Negotiating Expertise
Tips to Success
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Stop reinventing the wheel
Share resources, best practices, and what didn’t work
Collaborate, Network connect with someone new today
Be accessible to the Team
• Administration, Physicians, Staff and Patients
• Let the owners of the process make the changes
• Avoid negative verbiage, restate it in a positive manner
• Focus on improving a process not blaming a person
Stroke is a TEAM sport have fun and enjoy what you do!
Stroke Champions:
Sustain the Infrastructure
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Maintain State Designation
Educate (Staff/Physicians/Patients)
Policy & Procedures update
Updated Guidelines
Data Abstraction & Analysis (Coverdell/GWTG)
Quality Improvement (Concurrent RCA)
Outreach (EMS/Community/Physicians)
Networking/Collaboration (GA-SPA, AHA/ASA)
Professional Development (SCRN/CNRN/ENA)
Research (GA-StrokeNet)
Quality Improvement
• Regulatory Preparation: State, ATSC, PSC, CSC
• Know the strengths and weakness of the program.
• Mock drills, participate in Stroke Alerts, daily rounds
• Manage data (concurrently if possible)
• Prioritize PI projects
• (RCA: root cause/rapid cycle analysis).
• PDCA- then recheck, recheck, recheck
• Patient & Family Experience
• Celebrate Successes!
Stroke
Education…………Forever………
• EDUCATE (ASLS/FAST)
• ED, ICU, M/S Tele, Rehab, RRT, Supervisors, Ancillary Support, Lab,
Radiology, Volunteers, All Staff.
• Off Services- OB, orthopdedics, surgery, cardiac, oncology, all
patients & visitors
• Competencies: web based or check off (test and verify)
• Community/Family/Self
• Schools, churches, businesses, assisted living, ECF/LTAC, Health
Fairs, Community events- sport events, concerts, festivals
• 911 Dispatch/EMS/Paramedic/Fire Fighters
Continue to Advance the Program
• Professional Development
• Obtain Certification in specialty: SCRN, CNRN, ASLS
Instructor, CEN, CPHQ, CHCQM, CNS, RN-BC
• Participate in Professional Organizations: AANN,
AHA/ASA, NSA
• Networking & Collaboration
• GA-SPA, Conferences, Strike out Stroke, ASLS classes,
Health Fairs, Schools, Businesses
• Research
• Publication, present at local, state, regional & national
conferences, participation in GA-Net
AHA/ASA Partnership
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Legislative Advocacy
National Expertise/Guidelines
International Stroke Conference (ISC)
Local/State Mentoring
Coverdell/GWTG Partnership
Target Stroke Honor Roll
Silver/Gold Plus Award’s
Mock Regulatory Survey’s
Community Education
Georgia Coverdell Partnership
• BI-Monthly Teleconferences
• University of Miami’s Advanced Stroke Life Support
(ASLS) course free to participating hospitals
• Provides QI consultant to hospital staff
• Re-abstraction inter-rater reliability to monitor data
abstraction accuracy
• Quarterly Newsletter with hospital highlights
• Educational Resource for hospitals
Georgia Stroke Professional
Alliance (GA-SPA)
Mission Statement
The Georgia Stroke Professional Alliance is Committed to
Stroke Prevention and Optimizing Stroke Care through
Professional Networking and Education
July 2009
GA-SPA Partnership
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Quarterly meetings
Education for Stroke Champions
Community education
Strike Out Stroke
Research (ISC, AANN, GA-Net)
SCRN/CNRN Review Courses
ASLS Instructors
Mentoring
List Serve
Website
Successful Sustainability Reminders
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Stroke Champions- Never a one person job
It’s ALL about Partnerships/Networking
Know your data-Opportunities
Transparency to staff and community
Celebrate Success “every day”
Market Program to Community, Physicians, Staff
• Patient stories
• Education events
• Sport events, Festivals
Stroke is a TEAM sport have fun and enjoy what you do!
Accreditation Choices
GA - State Certification (RTSC)
• DNV-Det Norske Veritas
• HFAP- Healthcare Facilities Accreditation Program
• TJC- The Joint Commission State Certifications
THANKS to a GREAT TEAM
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Dr. McCord Smith (St. Mary’s)
Montez Carter & Beth Watkins (Good Samaritan)
Kerrie Krompf & James Lugtu (GA Coverdell Registry)
Joyce Reid (Georgia Hospital Association)
Chris Threlkeld, David Briscoe (EMS Experts)
Keith Wages & Ernie Doss (State OEMS)
Dr. Michael Frankel & Shelley Nichols(Grady Memorial
Hospital)
To each of YOU for being here today !!!