mark goldberg, md ut southwestern medical center lss annual meeting - november 6, 2015
TRANSCRIPT
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NASCARENursing-driven Acute Stroke Care
Mark Goldberg, MDUT Southwestern Medical CenterLSS Annual Meeting - November 6, 2015
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Julian Yang, MD (now at Duke)
Michelle Provencher, RN, MS◦ LSS and NASCARE Lead Coordinator
Mark Goldberg, MD (PI) DaiWai Olson, RN, PhD Robin Novakovic, MD Steven Figueroa, MD
TBN research coordinator
Investigator Team
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The target time for delivery of IV TPA is < 60 min from hospital arrival (door-to-needle time)
Many hospitals do not meet this metric
Average door-to-physician log-on time in telestroke encounters nationwide was 76.3 minutes Ref: Targeting Telestroke: Benchmarking Time Performance in
Telestroke Consultations (Yang et al., 2013)
Background
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Acute stroke delivery metrics can be improved by providing ED nurses with:◦An educational platform ◦An organizational tool◦A standardized stroke code protocol based
on core principles inspired by a “pit stop” care model
NAS-Care Hypothesis
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1. Identification of shared goals
2. Organized urgency with the removal of gatekeepers
3. Multi-personnel, parallel processing
4. Focus on defined staged roles and tasks
5. Empowered engagement, empowered responsibility
NAS-Care Principles
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The nurse is the usually the first person to see the patient
Takes responsibility for t-PA <60 minutes
Provides information needed to make a t-PA decision to physician as quickly as possible
The RN is the DRIVER
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Phase 1 – Site Selection and PreparationPhase 2 – Data Collection: Baseline (3 months)Phase 3a – NAS-Care Protocol Implementation
o NIHSS trainingo Site Visit
• Educational Lecture: “Time is Brain/Racing to the Finish”
• Mock Code Drills - “The 30-minute Stroke Code”o NAS-Care Run Sheet Implementation
Phase 3b – Data Collection: NAS-Care (6 months)Phase 4 – Exit Procedures
NASCARE Research Plan
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Door-to-Provider (DTP) Door-to-CT (DTCT)
Door-to-Ready (DTR)◦“Ready” signifies acquisition of all data points
needed to make a decision for t-PA
Door-to-Specialist (DTS) Door-to-Needle (DTN)
Key Metrics
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NAS-Care started data collection eight months ago
Two hospital in East Texas are currently collecting data
To date, 86 patients have been enrolled
NAS-Care Progress
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Three more hospitals in North and West Texas to start data collection in the next year
Partner hospitals of other LSS coordinating centers to start data collection◦ UT Health Science Centers – San Antonio and
Houston have made great progress, and are both IRB approved
◦ Seton Healthcare Family is currently waiting for any proposed changes to be finalized
Reviewing for possible protocol changes for endovascular therapy
Future direction
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Thank You