The stroke navigator: meaningful use of the electronic health record to efficiently report inpatient stroke care quality

Nathan, Jay K.; Foley, Jenevra; Hoang, Tiffany; Hiner, James; Brooks, Stephanie; Gendreau, Julian; Meurer, William J; Pandey, Aditya S.; Adelman, Eric E.

doi:10.1093/jamia/ocy102

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…These same electronic health records are capable of electronically identifying patients with strokes, automating data collection, and electronically reporting quality metrics used to improve care delivery for patients with stroke. 57…”

Section: Disposition: Transition Of Carementioning

confidence: 99%

“…Examples of how data drive QI in acute stroke care include (1) collecting data at different time points in the evaluation and being able to reduce treatment times, 5,32 (2) monitoring for alteplase complications and developing an improved postprocedure checklist, (3) collecting data on atypical stroke presentations and incorporating those elements into a triage worksheet, 27 and (4) using data to evaluate adherence to documentation requirements and creating nurse reminders or to enhance workflow in the electronic health record. 57 Certified stroke centers incorporate many of the aforementioned QI projects as part of their larger performance improvement plans. Shared data and successful improvement projects support the efforts that lead to successful stroke systems of care.…”

Section: Quality Improvementmentioning

confidence: 99%

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Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care): Update to the 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

Ashcraft¹,

Wilson²,

Nyström³

et al. 2021

Stroke

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The year 2020 was the year of the nurse, celebrating nurse scholarship, innovation, and leadership by promoting scientific nursing research, improving nursing practice, advancing nursing education, and providing leadership to influence health policy. As architects of stroke care, neuroscience nurses play a vital role in collaborating and coordinating care between multiple health professionals. Nurses improve accessibility and equity through telestroke, emergency medical services, and mobile stroke units and are integral to implementing education strategies by advocating and ensuring that patients and caregivers receive stroke education while safely transitioning through the health care system and to home. Stroke care is increasingly complex in the new reperfusion era, requiring nurses to participate in continuing education while attaining levels of competency in both the acute and recovery care process. Advanced practice nurses are taking the lead in many organizations, serving as prehospital providers on mobile stroke units, participating as members of the stroke response team, and directing stroke care protocols in the emergency department. This scientific statement is an update to the 2009 “Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient.” The aim is to provide a comprehensive review of the scientific evidence on nursing care in the prehospital and hyperacute emergency hospital setting, arming nurses with the necessary tools to provide evidenced-based high-quality care.

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Section: Disposition: Transition Of Carementioning

confidence: 99%

Section: Quality Improvementmentioning

confidence: 99%

Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care): Update to the 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

Ashcraft¹,

Wilson²,

Nyström³

et al. 2021

Stroke

View full text Add to dashboard Cite

show abstract

“…Of the organisational quality indicators, four related to accessibility and measured delays before a service was obtained. The indicator with a high frequency of occurrence (12) was delay for the first rehabilitation assessment 16 19 28–37. Two indicators related to equity of access in terms of access relative to geographical context or fair and equal access.…”

Section: Resultsmentioning

confidence: 99%

“…Of the clinical quality indicators, 12 related to safety and referred to the management of stroke risk factors and complications and included the indicator with the highest frequency of occurrence (19): dysphagia screening 19 28–31 34–41 43 45–49. Four indicators were grouped under effectiveness to assess health outcomes or achieve a care or service objective.…”

Section: Resultsmentioning

confidence: 99%

Clinical and organisational quality indicators for the optimal management of acute ischaemic stroke in the era of thrombectomy: a scoping review and expert consensus study

Bélanger,

Beaudet,

Lapointe

et al. 2024

BMJ Open

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ObjectiveThe purpose of this study is to identify clinical and organisational quality indicators conducive to the optimal interdisciplinary management of acute-phase ischaemic stroke.MethodA scoping review based on the six-step methodological framework of Arksey and O’Malley (2005) was conducted including a Delphi process with an experts committee.Data sourcesMEDLINE, CINAHL, Academic search complete, Cochrane Library databases, in addition to Google Scholar and Google were searched through January 2015 to February 2023.Eligibility criteriaFrench and English references, dealing with clinical and organisational indicators for the management and optimal care of adults with acute ischaemic stroke.Data extraction and synthesisAfter duplicate removal, all publications were checked for title and abstract. The full text of articles meeting the inclusion criteria was reviewed. Two independent reviewers performed 10% of the study selection and data extraction. Data collected underwent descriptive statistics.ResultsOf the 4343 references identified, 31 were included in the scoping review. About 360 indicators were identified and preliminary screened by two stroke experts. Fifty-four indicators were evaluated for validity, relevance and feasibility by a committee of experts including a partner patient using a Delphi method. A total of 34 indicators were selected and classified based on dimensions of care performance such as accessibility of services, quality of care and resource optimisation. Safety accounted for about one-third of the indicators, while there were few indicators for sustainability, equity of access and responsiveness.ConclusionThis scoping review shows there are many clinical and organisational indicators in the literature that are relevant, valid and feasible for improving the quality of care in the acute phase of ischaemic stroke. Future research is essential to highlight clinical and organisational practices in the acute phase.Registration detailshttps://osf.io/qc4mk/

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“…Such a model could be extended to the PAC setting once standardized data elements and associated regulatory requirements are established. 75…”

Section: Cross-setting Issues In Stroke Care Transitionsmentioning

confidence: 99%

Nursing’s Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community

Camicia

Lutz

Summers

et al. 2021

Stroke

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Facilitating successful care transitions across settings is a key nursing competency. Although we have achieved improvements in acute stroke care, similar advances in stroke care transitions in the postacute and return to community phases have lagged far behind. In the current delivery system, care transitions are often ineffective and inefficient resulting in unmet needs and high rates of unnecessary complications and avoidable hospital readmissions. Nurses must use evidence-based approaches to prepare stroke survivors and their family caregivers for postdischarge self-management, rehabilitation, and recovery. The purpose of this article is to provide evidence on the important nursing roles in stroke care and transition management across the care continuum, discuss cross-setting issues in stroke care, and provide recommendations to leverage nursing’s impact in optimizing outcomes for stroke survivors and their family unit across the continuum. To optimize nursing’s influence in facilitating safe, effective, and efficient care transitions for stroke survivors and their family caregivers across the continuum we have the following recommendations (1) establish a system of coordinated and seamless comprehensive stroke care across the continuum and into the community; (2) implement a stroke nurse liaison role that provides consultant case management for the episode of care across all settings/services for improved consistency, communication and follow-up care; (3) implement a validated caregiver assessment tool to systematically assess gaps in caregiver preparedness and develop a tailored caregiver/family care plan that can be implemented to improve caregiver preparedness; (4) use evidence-based teaching and communication methods to optimize stroke survivor/caregiver learning; and (5) use technology to advance stroke nursing care. Nurses must leverage their substantial influence over the health care delivery system to achieve these improvements in stroke care delivery to improve the health and lives of stroke survivors and their families.

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The stroke navigator: meaningful use of the electronic health record to efficiently report inpatient stroke care quality

Cited by 4 publications

References 13 publications

Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care): Update to the 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care): Update to the 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

Clinical and organisational quality indicators for the optimal management of acute ischaemic stroke in the era of thrombectomy: a scoping review and expert consensus study

Nursing’s Role in Successful Stroke Care Transitions Across the Continuum: From Acute Care Into the Community

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