1. Camden Clark Medical Center Barriers to Stroke Certification 2013 Loni Collins RN, CCRN Stroke Coordinator

2. Purpose To provide an overview of some of the barriers at Camden Clark Medical Center related to Primary Stroke Certification To provide an overview of some of the barriers at Camden Clark Medical Center related to Primary Stroke Certification

3. Objectives History of St. Joseph Hospital History of St. Joseph Hospital History of Camden Clark Medical Center History of Camden Clark Medical Center Explain Merger Explain Merger Explain Cultural Differences between Campuses Explain Cultural Differences between Campuses Identify barriers to obtaining Stroke Certification Identify barriers to obtaining Stroke Certification

4. History of Saint Joseph Hospital 1900’s a Roman Catholic Bishop founded hospital 1900’s a Roman Catholic Bishop founded hospital 1960’s a long range plan developed 1960’s a long range plan developed 1977 expanded to 216 beds 1977 expanded to 216 beds 1996 Sisters of Saint Joseph & HCA 1996 Sisters of Saint Joseph & HCA had a joint venture- Sisters ended 2001.

5. Saint Joseph (cont.) 2007 bought by Signature 2007 bought by Signature 2011 joined WV United Health Systems to become part of Camden Clark Medical Center Saint Joseph Campus 2011 joined WV United Health Systems to become part of Camden Clark Medical Center Saint Joseph Campus

6. History of Camden Clark Memorial Hospital 1898 City Hospital with 40 beds 1898 City Hospital with 40 beds 1918 Anne Camden dies & leaves mansion to the City for use as hospital 1918 Anne Camden dies & leaves mansion to the City for use as hospital 1920 moved to Camden Mansion 1920 moved to Camden Mansion

7. History of Camden (cont.) Subsequent donation from Dr. Clark allowed a new hospital wing Subsequent donation from Dr. Clark allowed a new hospital wing 1920 in recognition of Camden & Clark’s gifts it was dedicated as Camden-Clark Memorial Hospital 1920 in recognition of Camden & Clark’s gifts it was dedicated as Camden-Clark Memorial Hospital

8. Camden Clark Medical Center 2011 Camden Clark merged with Saint Joseph’s to become Camden Clark Medical Center, an affiliate of WV United Health Systems. 2011 Camden Clark merged with Saint Joseph’s to become Camden Clark Medical Center, an affiliate of WV United Health Systems.

9. 2 Different Cultures Saint Joseph’s Saint Josephs hospital was primarily a “for profit” hospital Saint Josephs hospital was primarily a “for profit” hospital Higher Socio- economic clientele Higher Socio- economic clientele Lower daily census Lower daily census Camden Clark Camden Clark hospital was a “not for profit” hospital Camden Clark hospital was a “not for profit” hospital Lower Socio-economic clientele Lower Socio-economic clientele Higher daily census Higher daily census

10. 2 Different Campuses Saint Joseph’s CT Scanner not available 24/7 CT Scanner not available 24/7 No Residents No Residents No Hospitalists No Hospitalists Avg ED visit Avg ED visit 40-60 pts/day 40-60 pts/day Limited Tech coverage Limited Tech coverage Not trauma designated Not trauma designated Memorial CT Scanner available 24/7 CT Scanner available 24/7 Residents Residents Hospitalists Hospitalists Avg ED visit Avg ED visit 100-120 pts/day 100-120 pts/day Tech coverage 24/7 Tech coverage 24/7 Designated Level 3 Trauma Center Designated Level 3 Trauma Center

11. Primary Stroke Center Organizationally, the decision was made to designate the Memorial Campus to be the Disease Specific designated Primary Stroke Center

12. General Barriers Difference in level of care between the 2 campuses Difference in level of care between the 2 campuses Assuring appropriate care for the stroke patient on St. Joseph’s campus Assuring appropriate care for the stroke patient on St. Joseph’s campus Ongoing state of change in organization encompassing many service lines Ongoing state of change in organization encompassing many service lines

13. Specific Barriers Building a case for the Stroke Coordinator Position Building a case for the Stroke Coordinator Position Physician Engagement Physician Engagement (Locums) (Locums) Pushing the changes through to the Emergency Department Pushing the changes through to the Emergency Department Establishing appropriate policy for 2 different campuses with 2 different procedures Establishing appropriate policy for 2 different campuses with 2 different procedures

14. Specific Barriers (cont.) Extensive educational needs Extensive educational needs Encouraging patients to choose Memorial Campus without compromising EMTALA Encouraging patients to choose Memorial Campus without compromising EMTALA Ongoing challenges with house wide EMR specific to building reports and documentation tools Ongoing challenges with house wide EMR specific to building reports and documentation tools Limited Experience with Joint Commission Process related to Disease Specific Certification Limited Experience with Joint Commission Process related to Disease Specific Certification

15. Where We Are…. Full time Stroke Coordinator in place Full time Stroke Coordinator in place Core Stroke Team of 3 members established Core Stroke Team of 3 members established Stroke Council of 21 members established Stroke Council of 21 members established Stroke alert policy, Stroke Alert Algorithm both approved for use Stroke alert policy, Stroke Alert Algorithm both approved for use

16. Where We Are…(cont.) Education in progress Education in progress Established a time line goal for application of Stroke Certification in March 2014 Established a time line goal for application of Stroke Certification in March 2014

17. Questions? Any questions, comments or suggestions? Any questions, comments or suggestions?