GOT DATA! NOW WHAT?

Angela Overton MSN, RN, CNRN

Quality Care Reviewer-Stroke

Clinical Quality, Safety & Performance Improvement

DISCLOSURE

v Nothing to disclose

OBJECTIVES

v Using the Iowa Stroke Registry to facilitate

change in an organization

v Identify and analyze data to help with

performance improvement project related to

stroke outcomes

RUNNING THE REPORT

WHAT THE REPORT IS TELLING YOU

When there is an

Opportunity For Improvement

How do I know who it is???

Measure

Set Name of measure Baseline STK 1 VTE prophylaxis 50.0 % STK 2 Discharge on antithrombotic therapy 95.2 % STK 3 Anticoagulation therapy for atrial fib/flutter NA STK 4 Thrombolytic therapy 50.0 % STK 5 Antithrombotic therapy by end of hospital day 2 95.2 % STK 6 Discharge on statin 72.2 %

STK 7 Dysphagia screening 43.5 % STK 8 Stroke education 28.0 % STK 9 Smoking cessation NA STK 10 Assessed for rehabilitation 60.0 %

STROKE PROTOCOL USED 5.0 %

OH BOY!

WHAT IS THE NEXT STEP

v Who can help you? Stakeholders

v Identify the goal

v Gather the troops

v Develop a plan

v Implement it

v Re-evaluate frequently

v YOU!!!

v Stroke physician champion

v ED physician

v Administration

v EMS Personal

v Unit Manager

v Educators

v Staff

v Data abstractor

v Information Technology

STAKEHOLDERS

IDENTIFYING GOAL

v End date

v They go by twos

v Ask yourself questions? •  What value is this bring to the

stroke community? •  Is this do able? •  What am I willing to do to help

get us there?

GATHER THE TROOPS

v Purpose/Role

v Brainstorm

v Get everyone’s input

DEVELOP PLAN

v Where

v How

v Why

IMPLEMENT THE PLAN

JUST DO IT!!!!

v Presentation-staff meetings

v Poster Boards

v 1 on 1 communications

v 1 on 1 just in time teaching

REEVALUATE

v Look where the program is going

v Small moves are still moves

v Reset goal

v Don’t forget to celebrate little success

MeasureSet

Baseline 2006 2007 2008 2009 2010 2011 2012 <YTD>

STK 1 VTE Prophylaxis 50.0% 90.0% 94.0% 98.6% 100.0% 99.6% 98.6% 99.3%

STK 2 D/C on antithrombotic 95.2% 98.0% 100.0% 98.5% 100.0% 100.0% 99.5% 99.2%

STK 3Anticoagulant Therapy for Atrial Fib/Flutter

NA 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

STK 4Thrombolytic Therapy 50.0% 50.0% 65.0% 93.7% 88.0% 90.0% 92.9% 100.0%

STK 5Antithrombotic Therapy by End of Hospital

95.2% 98.0% 100.0% 96.0% 97.0% 99.5% 100.0% 98.5%

STK6Discharge on Statin 72.2% 79.0% 69.0% 84.0% 100.0% 92.6% 97.0% 99.0%

STK7Dysphagia Screening 43.5% 57.4% 43.5% 65.0% 87.0% 93.0% 98.0%

STK8Stroke Education 28.0% 64.0% 70.0% 98.5% 92.7% 96.0%

STK 9Smoking Cessation NA 29.4% 100.0% 100.0% 100.0%

STK 10Assessed for Rehabilitation 60.0% 98.0% 100.0% 100.0% 100.0% 100.0%

STROKE PROTOCOL USED 5.0% 5.0% 25.0% 91.0% 89.0% 90.0%

Year # of stroke alerts

# tpa # of Door to needle less

than one hour

Ischemic stroke

2004 & 2005 24/48

2006 53 4 0

2007 59 10 0

2008 82 17 0

2009 87 19 4 186

2010 107 < EMS to call in field>

25 6 262

2011 115 25 11 268

2012 YTD

82 < Stroke Coordinator attends Stroke Alerts>

18 14 239

CONCLUSION

v  Know the numbers

v  Make a case for change

v  Have the right people at the table

v  Set a Goal, re evaluate, take a breathe,

modify if needed

v  Remember You Are Not Alone

Help is out there!!

v  The Most Important Thing!

CONCLUSION

YOU!!!

RESOURCES

v  Iowa Department Of Public Health •  http://www.idph.state.ia.us

v American Heart Association •  http://my.americanheart.org/professional/StatementsGuidelines/

ByTopic/TopicsQ-Z/Stroke-Statements-Guidelines_UCM_320600_Article.jsp

v  Iowa Healthcare Collaborative-Tool Box •  http://www.ihconline.org

v National Stroke Association

MENTORS

v  Erin Rindels- University of Iowa, Iowa City 319.384.7183 erin-rindels@uiowa.edu

v  Terri Hamm- Mercy Des Moines 515.358.0048 THamm@mercydesmoines.org

v  Jennifer Thoe- North Iowa Mason City 641.422.7109 THOEJ@mercyhealth.com

v  Susan Fowler- Great River Burlington 319.768.1509 sfowler@grhs.net

v  Angela Overton-University of Iowa 319.384.8234 angela-overton@uiowa.edu

QUESTIONS?