Keeping Up!

As we turn to fall, we thought it might be helpful to compile a list of “go-to” resources for stroke program leaders to keep on hand.  Something about the change in season and the back-to-school atmosphere has me making lists and getting organized both in my personal and professional life.

Of course, stroke program leaders are familiar with The American Stroke Association.  However, several other professional organizations offer guidelines and other resources related to stroke care including the American Association of Neuroscience NursesAssociation of Neurovascular Clinicians, Society of Vascular and Interventional Neurology, and Neurocritical Care Society. Joining list-servs through these professional organizations or regional stroke coordinator groups is also helpful.

If you are looking to expand your knowledge about healthcare quality, several organizations offer resources for free or for a small fee.  The Institute for Healthcare Improvement offers several free resources on quality, and they offer the IHI Open School with multiple courses on healthcare quality and improvement.  The courses are either free or for a small fee depending on your organization’s affiliation with the IHI.  The Agency for Healthcare Research and Quality has a large repository of free resources, including basic healthcare quality information.  The AHRQ search engine searches multiple government sites and can be helpful when researching stroke quality indicators and large data sets on stroke mortality.  They also have a great resource to assess healthcare quality and disparities by state.  

If you need to brush up on your basic excel skills, Technology for Teachers and Students has a great excel basics video and an intermediate excel tutorial.  You can then apply those skills using the Spinnaker Health Care Solutions YouTube channel where you will find great short videos teaching key excel and data management skills using stroke data templates tailored to stroke program leader needs.  

If you want to stay current on regulatory changes, sign up for e-Alerts or Advisories from stroke program certification agencies.

Another way to be sure to get timely certification agency stroke program updates is to connect with someone in your regulatory department and make sure they know what you need. For Medicare (CMS) changes in reimbursement or coverage, connect with someone in your finance department and coordinate getting any changes that impact the stroke program.

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!


Sarah Livesay, DNP, APRN, FNCS, FAAN

Debbie Hill, BS, FAHA

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By now, we are sure you’ve seen the latest guidelines from the American Stroke Association on the management of spontaneous intracerebral hemorrhage published in May of 2022. 

Has your program taken the appropriate steps to review the guideline and update your order sets, guidelines and/or clinical pathways to reflect the changes? And how do you handle disparate practice amongst care providers or disagreement with the guidelines? 

The publishing of a significant new guidelines offers an opportunity to reflect on the role guidelines play in your program and how to systematically approach guideline review.  An organized approach ensures you are both optimizing the care of your patients using an evidence-based approach and success during your next stroke program review. 

Guidelines offer a synthesis of the studies published on a certain disease by experts in the field.  Over the past decade, many societies adopted new methodologies to generate guidelines intended to increase the rigor and minimize bias.  This has resulted in both improved guidelines and also changes in guideline recommendations as a result of more rigorous methodology.  However, one of my favorite sayings about guidelines is that they are supposed to be the beginning of the conversation, not the end.  Guidelines are intended to summarize the best evidence applied to the broadest population of individuals.  They are not meant to be rules that are applied indiscriminately to all patients.  Some patients may require a deviation from suggested care in a guideline because the care provider is individualizing care to that individual.  These situations are expected and appropriate, and documentation to justify the decision should be evident in the medical record. 

The best approach to a newly published guideline is to pull all resources (order sets, protocols, pathways, policies, etc) and compare new recommendations against program resources.  When the resource deviates from a published recommendation, this warrants a team discussion with key leaders in the program including physicians, advanced practice providers, nurses, pharmacists and program administrators.  The strength of the recommendation and evidence used to make the recommendation should be reviewed in the context of the population the program serves.  The team must make a decision to either follow the recommendation in the guideline and update program resources, or to deviate from the guideline.  If the choice is made to deviate when planning program resources, the contextual program reasons for the decision should be well documented in meeting minutes or somewhere similar.  Then, program documents should be updated accordingly.  However, providers may still individualize care to patients and should document the reasons why care may differ from program resources and why this is best for the patient. 

Using an organized approach to reviewing and applying clinical practice guidelines is a key skill of a stroke program leader and will minimize the risk of findings on your next certification review.  Most importantly, it will ensure you are providing the best program resources for providers to care for your patients.    


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

Debbie Hill, BS, FAHA

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Control charts employ statistics to help you gauge if your process measures require intervention.  They allow you to track the effects of a quality improvement measure on the data and to respond to multiple data points instead of just an unfortunate case or data point.  As a result, you review individual cases in relation to trends from other cases to decide if a process is working for your program or if it’s time for a change.  This tool allows you to analyze and react to trends rather than allowing the last challenging case to overinfluence your team discussions.

Timeliness data (e.g., time-to-thrombolytic, time-to-groin puncture, etc.) are perfect processes to monitor using control charts.  Surprisingly, few stroke programs use control charts.  This may be because it requires some statistical knowledge and excel spreadsheet skills.  But once you learn how to build a control chart using Excel, you can quickly convert your standard line graph into a control chart

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

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

“The workshop was perfect. Very informative. I liked the fact that the spreadsheet had a built-in tab illustrating the formulas and the cells. Very easy to follow.”

“Very straightforward and easy to understand!”

“Easy to follow and understand! Excellent workshop!”

“I really liked all of this workshop.  I use these charts all the time but even the review of the basics was great. I never knew the difference between a histogram and bar chart.”

“Great job, very helpful information and relevant examples.” 

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.