Research has shown patients who have a stroke while hospitalized for another reason have worse outcomes than patients receiving treatment in the Emergency Department (ED). There are many reasons for this such as sicker patients, more severe strokes, lower adherence to process-based quality measures, and lack of a response team. Improving response and treatment time to in-hospital strokes at Hospital A by including a physician on the Rapid Response Team is the focus of this paper.
According to the American Heart Association / American Stroke Association’s About Stroke (2014) “stroke is the number four cause of death and the leading cause of adult disability in the United States” (para.1). ...view middle of the document...
Currently Hospital A has a Rapid Response Team (RRT) in place which responds to stroke calls in both the ED and in the hospital. The organization provides evidence-based care to stroke patients including the timely administration of t-PA and mechanical interventions. However, Hospital A shares the concerning delays and poor outcomes for patients experiencing stroke in the hospital.
A multidisciplinary team was identified to analyze the current in-hospital stroke response at Hospital A. The team consisted of representation from quality Management, Radiology, Lab, stroke units, neurologists, hospitalist and critical care services, Stroke Coordinator, Neuroscience Program Coordinator and the Director of Neuroscience Services. Several meetings were held to discuss current state and plan future state. Research was identified regarding improving the quality of care and outcomes for patients experiencing an in-hospital stroke. Based on these discussions, the team identified the stakeholders who would benefit from improving the process. These include the patients, departments such as Lab, Radiology, units throughout the hospital and the organization as a whole.
Based on the research conducted the team identified potential solutions which include the following:
1. Education of staff about the rapid identification of the signs and symptoms of in-hospital stroke (Cumbler, et al, 2014)
2. Implementing a Rapid Response Team (Gesensway, 2007)
3. Education of staff about rapid notification of the Rapid Response Team (Park et al., 2009)
4. Having a physician be a part of the response team i.e. the hospitalist (Gesensway, 2007)
5. Real-time feedback (Cumbler et al, 2012)
Since the organization already has a RRT in place and education is consistently being conducted with caregivers it made sense to focus on the process itself. However, future education may be conducted differently based on research for this paper.
The current process has the team placing a call to the attending physician and if they were not responding then the nurse calls a hospitalist. A neurologist is not consulted unless the attending or the hospitalist requested one. This leaves too much room for delay in treating this time sensitive medical emergency.
As previously mentioned, Hospital A has an established RRT. Unfortunately due to timing it was not possible to conduct mock stroke alerts of the current process for the purposes of this paper. However, the project team reviewed the current process map and interviewed the RRT as well as unit nurses, radiology, lab and neurologists. It was through this process review and interviews that the team determined the missing link was a consistent physician; the 24/7 on call neurologist.
The project team agreed the best solution for Hospital A was to add a physician to the RRT. By adding a physician to the RRT patients experiencing in-hospital stroke will receive more timely assessment by a physician. Additionally, patients will receive...