Objective: The Joint Commission (TJC) Comprehensive Stroke Center (CSC) certification includes the standard that hospitals must use processes based upon clinical practice guidelines (CPGs) or evidence-based practice to facilitate the delivery of clinical care, including patients admitted directly from the Operating Room or Interventional Radiology. Included in this standard is the requirement that assessment and documentation post-procedure be consistent with selected CPGs. This project was designed to improve assessment and documentation adherence at a single academic hospital. Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team was created to identify ways to improve compliance for required assessments when recovering a patient. The team reviewed current policies, guidelines, and order sets related to post procedure assessments. Comparison of pre-intervention and post-intervention adherence to charting standards was performed. Pre-intervention patients included a review of 4 records by TJC CSC reviewers during their on-site visit. Each patient had insufficient documentation; therefore, the institution was cited in this area. Post-intervention patients were prospectively identified. A Neuro ICU Self-Audit Tool was created to identify patients, remind staff of required assessments, and serve as a self-audit tool affirming their adherence to the guideline. Additional interventions included education (via email, poster in-services, staff meeting updates, and one-on-one teaching) for Neuro ICU nurses. A Post Cerebral Arteriography order set was created and the electronic health record modified to make it easier to document assessments. Results: Compliance improved to 98% in 4 consecutive months. 100% of cases were reviewed by the primary and charge nurses. 10% of cases were reviewed by the stroke program data analyst to ensure accuracy and inter rater reliability. Outliers were reviewed by the stroke leadership team and feedback given to unit nursing leadership and the nurse. Conclusions: Improvement of adherence to post-procedure assessments is possible using the PDSA methodology. The success of this project allowed this hospital to achieve its TJC CSC certification.

Background: Stroke coordinators (SC) in Colorado meet monthly to share best practice and collaborate with the ASA and industry representatives. Based on informal observation, we believed that many of the coordinators were new in their roles and desired additional information and education on how to be successful. We teamed with the ASA and hosted two conferences; one for Colorado SCs and a larger conference for ASA Southwest affiliates. Demographic data was collected at both conferences. Methods: For the CO conference, surveys were sent to all SCs in the state. For the ASA conference, only those who attended were given the survey. Results were combined and content included: educational preparation, hospital volumes, certification status, reporting structure, orientation plan, role responsibilities, data expectations, and job satisfaction. Partial responses were included. Results: 94 surveys were returned. 70% were SCs for less than 2 years but 40% worked in their hospital for 1 - 5 years and 38% for >5 years. 32/41 worked at a primary stroke center (PSC) and 6/41 worked at a comprehensive stroke center. The majority (81%) were nurses (36% Diploma, 64% Bachelor’s prepared). 18% were Master’s prepared (NP, CNS, and MS in nursing but not NP or CNS). 43% either had a mentor or a structured orientation plan and exactly the same (43%) made up their orientation. 45% reported to Nursing, 40% to Quality, and few (2%) to Neurology. Respondents liked the ability to be creative and affect change at their hospital but disliked the lack of clarity in their role and the number of job functions they are expected to perform. Conclusion: SCs in the Southwest affiliate are primarily nurses with less than 2 years of experience as a SC who had worked at their hospital for at least 1 year but many for over 5 years. Most hospitals are PSCs. They equally had mentorship and training versus developing their role without much direction. SCs enjoy the ability to be creative and affect change but would like additional clarity and expectations to succeed in their roles.

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Background: Stroke coordinators (SC) are key stroke program personnel. However, little is known about the SC role or barriers to practice. We designed a role study to better understand barriers to SCs practice and contributors to burnout and and turnover. Methods: a role survey was developed using Dillman’s Tailored Design Methods and addressed orientation to role, mentoring and barriers to practice. The voluntary survey was distributed by email through three stroke organizations in Illinois and targeted SCs and advanced practice nurses (APN) with stroke program responsibilities. Results: 40 participants from 33 different facilities responded to the role survey. 65% of respondents identified as SC, 30% as stroke program manager/director, 20% as an APN. 17% had worked at other facilities previously as a stroke coordinator or similar role. 46% of respondents reported not having adequate resources to perform duties as stroke coordinator. Top reported moderate or extreme barriers to success in the role were lack of time (78%), lack of role clarity by supervisor (32%), lack of role definition as stroke coordinator (30%), lack of mentorship (27%), lack of on-the-job training (22%), and lack of formal education (19%). SCs and APNs with program coordination responsibilities report to a variety of different supervisor roles, including nursing management (38%), quality department (27%), other hospital administration (14%), service line management (8%), a physician (5%), other (6%). 70% of respondents reported they had not been mentored by anyone at their facility once hired into the role and 16% of coordinators reported they were considering leaving their position in the next year. Conclusions: While stroke coordinators and APNs with programmatic oversight are viewed as integral to program success, many are struggling with lack of role clarity, time management, adequate resources, and lack of mentorship. These factors may be contributing to turnover and burnout.

Background: The Licensed Clinical Social Worker (LCSW) scope of practice is similar to other healthcare providers in conducting assessments, providing diagnoses and recommending treatment plans. The LCSW is unique in that they are also equipped to assess a patient’s environment and other significant factors which impact individual needs and outcomes. The LCSW is skilled at providing individual, interpersonal and societal assessments helping to optimize biopsychosocial needs within the continuum of care. Integrating a social work perspective offers a unique vantage point within the CSC. Purpose: The purpose of this initiative was to align the LCSW scope of practice with the CSC scope of service and assess the CSC program from the LCSW perspective. The goal was to identify gaps in the care continuum to improve transitions of care, increase patient satisfaction, and reduce readmission rates. Methods: After implementing the LCSW role to assess transitional care needs identified by a gap analysis, the CSC utilized qualitative research and PDSA methodology to provide ongoing oversight and assessment and achieve the identified goals. The outcomes were determined by FY2017 to FY2018 data. Results: Based on identified gaps, the CSC established a stroke clinic for follow-up, and 7-day patient satisfaction phone calls were completed by the LCSW. In follow-up, 82% of scheduled patients were seen in the stroke clinic. Post-discharge LCSW intervention was provided to 74% of the 134 patients reached during the 7-day satisfaction phone call. Of the patients reached by phone, 82% reported satisfaction scores above average as compared to other healthcare experiences. The CSC Stroke Support Group attendance increased by 50%, from 12 to 24 survivors. CMS criteria for AIS readmission rates decreased from 7.20% out of 477 patients in FY2017, to 4.78% out of 474 patients in FY2018. Conclusion: In conclusion, implementation of the LCSW role had a positive impact on the CSC program, improving transitions of care, increasing patient satisfaction, and reducing readmission rates, thereby validating the efficacy of the role. It is recommended that other CSC programs consider integrating the LCSW role and perspective into their continuum of care.