Stroke Program Research: A Challenge for Even the Biggest and Best

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Comprehensive Stroke Centers (CSCs) certified by The Joint Commission, DNV and ACHC are expected to maintain a program of research generally defined as a study requiring International Review Board (IRB) approval and active enrollment of patients. Who better to accept this responsibility than CSCs with the largest and most acute patient populations?

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Ensuring a Successful Neurointerventional Radiology (NIR) Tracer

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As mechanical thrombectomy science evolved over the past decade, the neurointerventional (NIR) suite became a critical area for patient care and a focus of regulatory review for stroke certification.When assisting programs in seeking successful certification visits, we’ve noted a few common themes in need of attention in the NIR suite to ensure successful certification tracers. 

  • Staffing: There tends to be variation in how NIR suites are staffed across the nation in terms of number of staff, credentials of staff and roles of each staff member in the suite.  This is often more pronounced in organizations when the NIR suite is maintained separately from the cardiac catheterization suite.  Leadership should be aware of the differences and articulate how their model of staffing ensures patient safety while in the NIR suite.  Differences between how cardiac intervention cases and stroke intervention cases are staffed should be explored by leadership and easily explained if asked.  
  • Educational competencies: NIR suite leadership may manage education and competency assessment from several perspectives.  Companies with knowledge about devices frequently host educational talks or in-services for staff.  Content covered and attendance at in-services should be noted by NIR leadership and documented in staff files.  Information from device experts should be put

    into context for NIR staff by practitioners (e.g., physicians, advanced practice providers, stroke coordinators, lead technologists) so all staff are knowledgeable about how devices will be used in procedures at the organization.  Another great approach to NIR staff education is focusing on what staff should anticipate if an unexpected complication occurs during the case.  Discussion or even simulated cases of managing complications during procedures can help all room staff anticipate what is needed during a stressful event.  Finally, any staff managing patients with critical care needs in the NIR suite should have documented education and competencies related to critical care stroke management. 
  • Knowledge of performance improvement data: NIR staff should have knowledge of the program’s performance data and how they fit into the puzzle of fast and safe care.  This includes knowledge about the time from door to thrombolysis and mechanical thrombectomy times (first pass of device, recanalization time) and outcomes (TICI scores).  Staff should be articulate about how they ensure processes are followed to minimize delay and ensure safety.  Data should be readily available for staff, and they should be able to explain the information and why it matters to patient care.  
  • Management of critically ill patients: Some patients receiving care in the NIR suite are critically ill, such as patients with subarachnoid hemorrhage in the suite for intra-arterial management of cerebral vasospasm.  Roles and responsibilities of all staff in the room related to management of critical care needs including the external ventricular drain (EVD), intracranial pressure monitoring and management, vasopressors for blood pressure management, and mechanical ventilation should be clear. Documentation of frequent vital sign assessment, EVD monitoring and mechanical ventilation should also be clear in the medical record for patient tracers. Many traditional templates for the NIR or cardiac catheterization lab in electronic health records do not offer a place for documentation of these parameters and require editing to ensure complete documentation of monitoring.

Having an organized approach to these key areas will help to ensure a smooth certification review for your stroke program and will minimize the risk of findings on your next certification review.  Most importantly, it will ensure you are providing the best care for your patients.   

And as always, Stroke Challenges has several free resources including blogs on various stroke topics.  We also offer both e-books and on-demand webinar training on topics including how to put your best foot forward during your stroke program opening presentation for certification, mastering your data tracer and several helpful on-demand data management presentations and workshops.  Visit our website to see all that we offer!

STROKE CHALLENGES, CO-FOUNDERS

Sarah Livesay, DNP, APRN, ACNP-BC, ACNS-BC

Debbie Hill, BS, FAHA

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MOVING FROM ANECDOTES TO STRATEGIC PERFORMANCE IMPROVEMENT

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As we move into summer, we are continuing our partnership with Spinnaker Health Care Solutions to explore performance improvement tools for use in your stroke program.  One of the most common errors we witness in regular stroke program meetings is presenting program data without an analysis of the problem and proposed interventions to address the problem. Presenting data often triggers team members to begin sharing their experiences with the topic, and the conversation can quickly dissolve into shared anecdotes.  The problem with anecdotes is they often don’t provide reliable data to inform decision making.  Many errant PI interventions developed from anecdotal experiences.  This approach can be costly and time consuming. The experienced program leader is adept at PI tools that help analyze performance data and guide the team in choosing next steps wisely.  With the right tools, you can move from identifying a problem to confidently choosing the best next intervention.  

In this webinar, we will explore several tools in detail, including process mapping, fishbone analysis, the 5-whys root cause analysis, a PICK Chart and a Pareto Chart.  These tools equip the healthcare team to analyze causes of a problem and choose the best next step.  In addition to learning when to use these tools and how to analyze the data provided, you will also learn how to build a pareto analysis in Excel.  Using a few simple graphing keystrokes, you will be building pareto charts in no time.  

We developed an Excel tool and training webinar to help you learn how to build and master  Pareto charts. We give you an Excel template already populated with the “mock” data. The webinar walks you through building a Preto chart with the Excel template. You can also cut and paste your Stroke Log data into the Excel template and build a Pareto chart displaying your own data! Learn more about the webinar here.

We offered this training in a virtual workshop in June and got some great feedback that we’d like to share with you:  

“Appreciate these trainings which are very helpful for both new and experienced stroke coordinators, managers, and stroke leadership.”

“This workshop was definitely helpful in determining when to use certain process improvement methodologies or tools to analyze data and trends!”

“Great work on the workshops!  Thank you for continuing to put out such relevant and relatable material!”

“I enjoyed the demo of building/using a pareto, especially knowing that I have instructions and the template to use later.”

“Definitely enjoyed the walk through of the excel pareto chart.”  

Thank you to Dale Strong at Spinnaker Health Care Solutions for collaborating with us to develop this webinar and to ABBVIE for sponsoring the live workshop.

Stroke Data in the Era of COVID

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