1. Interdisciplinary Approach to Stroke Patients Stormont-Vail HealthCare Primary Stroke Center

2. Interdisciplinary Team Group of health care professionals from various expertise working together to improve patient care. Definition retrieved from http://medical-dictionary.thefreedictionary.com/interdisciplinary+team

3. Benefits of an Interdisciplinary Team for Stroke Patients Provide a standard of care Stroke is the No. 5 cause of death in the U.S. Every 4 seconds someone dies from a stroke Someone suffers a stroke every 40 seconds Stroke is the leading cause of disability Stroke is the leading preventable cause of disability Retrieved fromhttp://www.strokeassociation.org/STROKEORG/

4. Stroke Team History Steering committee started with administrative staff and Medical/Surgical Director Committee expanded to include departments directly linked to care of stroke patients Stroke Team was developed in 2009 Stromont-Vail planned to apply for Primary Stroke Center Accreditation in 2010 Identified and designated one unit to care for stroke patients Stroke unit interdisciplinary team developed for discharge planning

5. Stormont-Vail HealthCare Mission – Vision – Values for Stroke Care The Primary Stroke Center exists to benefit the individuals and the community we serve by providing comprehensive clinical care through: Stroke Prevention Stroke Diagnosis Stroke Evaluation and Management Stroke Education Stroke Rehabilitation An experienced team of health care professionals provide consistent, current, timely and expert care maximizing the probability of the most positive outcomes.

6. http://www.activase.com/iscstroke/golden-hour-acute-ischemic-stroke Expectations

7. Interdisciplinary Team Lab Phlebotomist Primary Nurse Pharmacist Physicians – ED and Hospitalist CT Technologist Stroke Unit Nurse Information Technology Registration Case Management/Social Workers Rehab Staff – Physical, Occupation, and Speech Therapist Dietician Stroke Unit Manager and Director Emergency Department Manager and Director Critical Care Manager and Director Telecom/Health Connections

8. What happens when a patient arrives with stroke-like symptoms? EMS notifies ED EMS and ED staff determines last known well ED staff activate Stroke Alert through Health Connections. All team members arrive at bedside ED Physician ED Nurse ED Pharmacist Stroke nurse Lab Phlebotomist CT clears table and scans patient.

9. Challenges Faced by Interdisciplinary Team Identification of potential stroke patients Communication between ancillary departments Radiology CT report results to physician Incorporate family in team and provide education Decrease Door to Needle Time Early assessment by rehab staff Discharge planning

10. Staff Development/Ownership

11. ED white board with TPA time goal Example Time TPA should be given by.

13. What happens when a patient gets admitted with a stroke? Admitted to designated stroke unit Standardized order sets utilized PT/OT/ST consult and treat Social work/case management consult Daily discharge planning rounds Concurrent review of all stroke patients daily Review of cases that receive TPA. Immediate feedback given to staff involved.

14. Interdisciplinary Team Improvements Developed new working relationships with multiple departments. Seamless care of the stroke patient. Increased usage of TPA to acute eligible stroke patients.

15. Improved TPA administration time Improved Lab and CT results times Interdisciplinary Team Discharge Rounds Stroke patient average length of stay 3 days Interdisciplinary Team Improvements

16. How we help patients… Get Back To Living. Stormont-Vail Stroke Team Standardized orders sets Stroke Unit Charge Leadership Team oversight of Stroke Standards Risk Factor Reduction Plan implemented for all patients prior to discharge

17. How we help patients… Get Back To Living. 7 day follow-up call for patients discharged home 90 day follow-up phone call Community education and outreach

18. Increased usage of TPA to acute eligible stroke patients

19. Stroke Specific Statistics Discharge Disposition

20. Contact Information Angela Rodecap BSN, RN, SCRN Stroke Program Manager arodecap@stormontvail.org 785-270-4020

21. Questions?