Abstract TP27: Satisfaction Survey Reveals Participants Accepted Technology Solutions To Improve Participant Access During A Pandemic

Background: C3FIT ( C oordinated, C ollaborative, C omprehensive, F amily-based, I ntegrated, T echnology-enabled Stroke Care) is a pragmatic, multi-centered. cluster-randomized trial to assess the superiority of patient outcomes when Joint Commission-certified Stroke Centers or Primary Stroke Center (CSC/PSC) are supplemented with an Integrated Stroke Practice Unit (ISPU) model of care at 9 of 18 hospitals across the United States. We describe participant satisfaction with technology solutions used to improve access during a Pandemic.

Methods: Participating sites were randomized to the CSC/PSC or ISPU Model, enrolling 100/site (n=1800). Guided by Kotter’s process for leading change, ISPU patient-centric (patient/ caregiver) model provides care through two coordinated units addressing acute assessment/diagnosis/intervention (Stroke Central or SM) through hospital discharge to 1-year post-stroke (Stroke Mobile or SMT). SMT includes a Registered Nurse and Lay Health Educator working with participants for 12 monthly visits at home/facility post-stroke. A participant satisfaction tool was used to assess their ability and preference to use technology.

Results: Enrollment began February 2020. March 2020 the Pandemic affected the study by: 1. Facilities altering visitation policies inhibiting SC/SMT interaction with participants to consent, 2. Facilities limited participant follow-up in their homes by SMT, 3. Participants limited in-home visits by SMT, 4. Institutional research programs were held. The Clinical Coordinating Center met challenges by adding phone visits, smart phone application and I-PADS for participant follow-up. ISPU sites increased phone/virtual visits to 89 %; home visits decreased to 9.9%. Participant’s survey found 94.7% were very or extremely satisfied with their “ability to use the virtual technology;” 28.4% preferred virtual follow-up; 40.9% preferred in-person; 30.7% preferred phone visits.

Conclusion: Conducting this study during the Pandemic presented challenges to enrollment and follow-up. Participants reported satisfaction with technology as a possible solution to improve clinical access.>

The Impact of Stroke Nurse Navigation on Patient Compliance Postdischarge

PURPOSE

The purpose of this study was to describe the impact a stroke nurse navigation program has on concurrent chart reviews and patient compliance postdischarge.

DESIGN

Phase I: Concurrent chart review of The Joint Commission Primary Stroke Center core measures for ischemic stroke patients. Phase II: Longitudinal study of 100 ischemic stroke patients discharged to home.

METHODS

Telephone surveys were conducted at prescribed intervals posthospital discharge (Phase II). Surveys focused on medication compliance, follow-up medical appointment compliance, and neurovascular emergency department (ED) visits/readmissions.

FINDINGS

Phase I trends included increased stroke performance measures compliance. Phase II favorable trends included increased medication compliance (>98%), increased follow-up appointments (100%), decreased rate of neurovascular ED visits/rehospitalizations (3%), and improvement in activities of daily living and quality of life measures through 12 months postdischarge.

CONCLUSIONS

Stroke nurse navigation increased conformity of stroke performance measures and stroke patient discharge compliance through 12 months postdischarge.

National and international quality initiatives to improve stroke care

Stroke, the second leading cause of death throughout the world, has a major impact on society. This article provides a summary of quality improvement initiatives, including those relating to hospitals, the system of care delivery infrastructure, and legislative efforts in the United States and in various countries outside of the United States. Through quality improvement initiatives, it is projected that stroke outcomes may improve and the economic burden of stroke may be reduced.

The impact of a neurointensivist-led team on a semiclosed neurosciences intensive care unit*

OBJECTIVE

To evaluate the impact of a newly appointed neurointensivist on neurosciences intensive care unit (NICU) patient outcomes and quality of care variables.

DESIGN

Observational cohort with historical controls.

SETTING

Ten-bed neurointensive care unit in tertiary university hospital.

PATIENTS

Mortality, length of stay (LOS), and discharge disposition of all patients admitted to the NICU were compared between two 19-month periods, before and after the appointment of a neurointensivist. Data regarding these patients were collected using the hospital database and the University Hospitals Consortium database. Individual patient medical records were reviewed for major complications and important prognostic variable documentation.

INTERVENTIONS

Appointment of a neurointensivist.

MEASUREMENTS AND MAIN RESULTS

We analyzed 1,087 patients before and 1,279 after the neurointensivist's appointment. The unadjusted in-hospital mortality decreased from 10.1% in the before to 9.1% in the after period (95% confidence interval, -1.3 to 3%, relative mortality reduction of 9.9%), but this decrease was significantly different than the expected increase of 1.4% in University Hospitals Consortium mortality during the same period (p = .048). The unadjusted mortality in the NICU decreased from 8% to 6.3% (95% confidence interval, -0.5 to 4, relative mortality reduction 21%) and mean NICU LOS from 3.5 to 2.9 days (95% confidence interval, 0.2 to 0.9, relative NICU LOS reduction 17%). A significant 42% reduction of the risk of death during the first 3 days of NICU admission (p = .003) and a 12% greater risk for NICU discharge (p = .02) were found in the after period in multivariate proportional hazard models. Discharge home increased from 51.7% in the before to 59.7% in the after period (95% confidence interval, 4 to 12, relative increase of 15%) and discharge to a nursing home decreased from 8.1% to 6.8% (95% confidence interval, -1 to 4, relative decrease of 16%). Although a higher total number of complications occurred in the after period, fewer of them occurred in the NICU (odds ratio, 0.2; 95% confidence interval, 0.08 to 0.54, p = .001); this may possibly be due to the better documentation by the NICU team in the after period.

CONCLUSIONS

The institution of a neurointensivist-led team model was associated with an independent positive impact on patient outcomes, including a lower intensive care unit mortality, LOS, and discharge to a skilled nursing facility and a higher discharge home.