Abstract P829: Bi-Directional Quality Review in a Large Telestroke Network: Improving Stroke Care Through Mutual Learning
| Autor: | Erin Ekstrom, Chona Dart, Tyler D Harman, Lee S Chung, Heather Wicks, Tawnie Reynolds, Jaleen Johnson, Lacey Christensen, Vivek Reddy, Jennifer J. Majersik, Peter M Hannon |
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| Rok vydání: | 2021 |
| Předmět: |
Advanced and Specialized Nursing
Quality management business.industry media_common.quotation_subject Stroke care medicine.disease Spoke-hub distribution paradigm medicine Quality (business) Neurology (clinical) Medical emergency Cardiology and Cardiovascular Medicine business media_common Mutual learning |
| Zdroj: | Stroke. 52 |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Introduction: Our hub and spoke telestroke (TS) network consists of 26 sites across 6 states, with >1000 consults/year. Without a shared EMR, patient outcomes are often unknown. We aimed to improve communication of patient outcomes and patient care by implementing multi-disciplinary quality review across multiple health systems. Methods: To determine interest in and format of the review, we first conducted interviews with coordinators from 3 highly engaged sites of varying sizes and capabilities. We had strong consensus that a bi-directional quality review would be helpful and that group-based discussion was preferred over single site review. Coordinators chose review flags of long process metrics, missed treatments, thrombectomies, complications, and mortalities with sentinel events reviewed immediately, off-cycle. A case review sheet is uploaded to HIPAA-compliant Box drive and neuroimaging to PACS. Hub and spoke present cases over Zoom using standard SOAR format: Situation, Outcome, Assessment, Recommendation. The group grades each case as standard of care (SOC) met, exceeded, or not met, +/- opportunities for improvement (OFI). Discussion includes recommendations to the individual hospital or network. Results: From 4/2019-7/2020, we conducted 8 bi-directional case reviews of 21 TS cases with 9 spokes (mean 4.3 spokes/review, range 2-6). Of 47 spoke participants, 43% were stroke coordinators, 34% were ED managers, with rare hospitalists present. Hub participants were 8 vascular neurologists/fellows and 3 TS coordinators/managers. Case content was 33% recognition, 49% acute treatment, and 19% disposition. SOC was rated as met or exceeded in 86% of cases with OFI noted in 100%. The Table details discussion themes. Conclusion: A bi-directional quality review can share knowledge and best practices across a large TS network, improving inter-facility communication and site engagement. We hope next to increase physician attendance and engage more sites. |
| Databáze: | OpenAIRE |
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