Improving Stroke Care Through Development of a Stroke Intervention Team: A Case Study

• Objective: To describe a program intended to achieve superior clinical outcomes in stroke care through appropriate use of interventional stroke reversal therapy. • Methods: A team charter was developed along with defined project objectives and associated outcomes. Timelines, team members, operating budgets, key stakeholders, and key patient and physician requirements were also defined. The team developed actions that included the production of an information packet for referring facilities, onsite visits with referring physicians/hospitals, modification of patient transfer protocol, collaborating with emergency department and nursing personnel, developing a marketing program for the public, increasing the clinical research effort, and establishing patient care protocols. • Results: The efforts have produced significant results, including improved NIHSS scores. Patient referrals have increased from the regional network of participating hospitals, resulting in a 31% increase in patient volume. The percentage of patients receiving stroke reversal therapy rose from 18% (2000) to 31% (2004). Profitability increased 85%. • Conclusion: A complex community health care need can be met successfully through the development of a new service program that involves multiple specialties and referral hospitals. Stroke is the third leading cause of death in the United States and is the leading cause of disability in adults [1,2]. Every year there are 750,000 new or recurrent strokes [1]. National treatment guidelines call for the administration of intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke of less than 3 hours’ duration in patients without contraindications [3]. However, the reported national rate of IV tPA use is only 2% to 3% [4,5]. In this paper, we describe our approach to improving stroke care at our medical center, including increasing appropriate use of thrombolytic therapy. Setting Saint Luke’s Hospital of Kansas City (SLH) is a voluntary not-for-profit comprehensive teaching and referral health care organization. It is Kansas City’s largest hospital, with 582 beds, 3214 employees, and a staff of 500 physicians. It is also the tertiary care referral center of Saint Luke’s Health System. The Mid America Brain and Stroke Institute (MABSI) of SLH was formed in 2001 to advance the practice of neuroscience and to further the work of SLH’s nationally recognized stroke program established in 1993. The committee is a cross-functional team of interdependent clinicians and support staff. Its mission is to achieve common goals and superior clinical outcomes, especially in improving SLH’s stroke intervention rate and utilizing advanced stroke reversal therapies. Selecting the Opportunity MABSI’s first step was to utilize an internally produced community environmental assessment that identified stroke as a key health care issue for the Kansas City region. Early investigation also revealed that no other hospitals in the Kansas City market had chosen to develop clinical expertise in the diagnosis and treatment of ischemic stroke. These facts made forming a stroke team a sensible response to a well-defined community need. The team was formed in recognition of high morbidity and mortality following stroke and the desire to improve care. In the first quarter of 2002, the MABSI committee reviewed a variety of neurovascular performance data. An analysis of demographic data for January 2000 through June 2002 revealed that over 70% of stroke patients who received acute intervention therapy were transferred to SLH from hospital emergency departments within a 100-mile radius. Over this 30-month period, 18% of all ischemic stroke patients presenting to SLH received IV tPA, intra-arterial (IA) tPA, or a combination of these. Although SLH’s intervention rate exceeded the national average by 15% to 16%, From the Mid America Brain and Stroke Institute and the Quality Resource Department, Saint Luke’s Hospital, Kansas City, MO.