Remote Treatment Stroke Center Designation

The Why and How toMay 14, 2015

Presenter’s Disclosures• McCord Smith, MD – none • Beth Watkins, RN – none• James Lugtu, RN, NP – none• David Briscoe, EMT-P – none • Debbie Camp, RN• 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• 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 VisitDevelop ChecklistLetter of Intent as remote stroke treatment center from

hospital CEOAppoint Medical Director for stroke programPrepare protocols (preprinted and electronic) Prepare pre-written stroke order set in collaboration with Hub

HospitalWrite policy on stroke notification system, with expected

response timesDevelop transfer protocolWork 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• 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

• 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

Excellent Stroke Care

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:• Administrative buy-in • Stroke Medical Director• Stroke Coordinator• Interdisciplinary Team has Stroke Champions

Hub & Spoke Partnership• 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 ClearCommunication and Negotiating Expertise

Tips to Success• 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 • 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• 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• 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• 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• 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 !!!