Abstract WP399: Improving Stroke and TIA Care in the Emergency Department: Results from a Provincial Stroke Improvement Collaborative
Background: Stroke and transient ischemic attack (TIA) are common disorders cared for by emergency physicians. Best practices exist for the management of these disorders; however, these are not always followed.
OBJECTIVES: This study sought to measure the impact of a coordinated, provincial structured improvement collaborative, on care for stroke and TIA patients within emergency departments (ED’s) in British Columbia.
METHODS: This study was a qualitative and quantitative process evaluation of a provincial improvement collaborative. The collaborative followed an Institute of Healthcare Improvement (IHI) Methodology, consisting of five workshops, bi-weekly webinars, and improvement coaching and support, over a 10-month period, from Sept 2011 to June 2012. This evaluation examined process measures of success, such as self-reported improvement and adherence to certain clinical process measures (e.g. time to CT). Collaborative participants submitted monthly reports that quantified their improvement using the Self Assessment Score, which is used in IHI Collaborative Methodology.
RESULTS: 17 multidisciplinary teams participated, representing 27% of all ED’s in British Columbia (29 / 108), and all five Health Authorities. Further, all but one of the province’s tPA enabled sites were represented. 90% of teams (15 / 17) reported a median Self Assessment Score greater than 4.5/5.0, indicating significant and sustainable improvements in stroke and TIA care. No teams dropped out of the Collaborative. Teams reported a mean of 5.5 (SD 2.4) significant improvements within their ED. For example, shortened door-to-CT times, improved triage and training, and implementation of standardized swallowing screens were shown. This collaborative showed higher success rates of self-reported improvement (typically only 30% of teams achieve significant improvement) and lower rates of dropouts, than the published literature.
CONCLUSIONS: Using an IHI structured collaborative format, a provincial stroke & TIA emergency department quality improvement initiative was able to achieve significant improvements in adherence to best practices. A formal outcome evaluation is planned to measure the impact on stroke incidence, disability, and mortality.
- © 2012 by American Heart Association, Inc.