Success key No. 4: Targeting the TIAs
A big concern for a hospital system is ensuring that patients don't go back to the hospital as 30-day readmissions. The Forsyth Medical Center has reduced its readmission rates in stroke care by working to "bridge the gap" of those who are discharged, says Gregory. The program is run out of the stroke center's Transient Ischemic Attack Center, a dedicated facility for rapid diagnosis and treatment of patients who experienced a TIA stroke, often known as a "ministroke."
The Stroke Bridge Clinic, another Forsyth Medical Center initiative, is an outpatient facility; it provides 30-minute follow-up appointments, as well as coordinating 20 minutes with a pharmacist and 20 minutes with a stroke navigator for stroke patients within one to two weeks after they are discharged from the hospital.
"Our data shows that a stroke patient has a greater chance of being readmitted to the hospital if they do not visit the Bridge Clinic," says Gregory. Indeed, 8.8% of patients who did not receive Bridge Clinic follow-up were readmitted in 2011, but only 2.6% of those who visited the Bridge Clinic were readmitted. Overall improvement continues. From January through July in 2012, readmission rates were 6% for non-Bridge and just 0.4% for Bridge patients.
A TIA occurs when a blood clot interrupts blood flow to the brain, and can last anywhere from a few minutes to 24 hours, but produces no visible damage and can disappear quickly. However, a TIA can be a precursor of things to come, with studies showing that half of all strokes are preceded by a TIA. Studies have shown that people who suffer strokes within 48 hours after experiencing a TIA often have a more debilitating or potentially deadly stroke.
The TIA Center at the Forsyth Stroke and Neurosciences Institute provides for fast-track diagnosis so treatment can be carried out quickly, reducing the risk of a full-fledged stroke in the future. The unit also treats diabetes, heart, or blood pressure problems, and high cholesterol and other conditions that could increase the risk of stroke.
With new protocols, the hospital also has substantially decreased lengths of stay as well as the 30-day readmissions, Gregory says. Both TIA lengths of stay and readmission rates were much lower in the TIA Center than for patients with TIAs admitted to other parts of the hospital. Average length of stay in the TIA Center from January to July of this year was 1.5 days, but was 2.8 days for all other hospital units, the hospital stated.
At the Stroke Bridge Clinic, a neurology nurse practitioner reviews patients' treatment plans to make sure that recovery is progressing as well as it should, according to the hospital. A stroke navigator also guides patients and their caregivers through the recovery process, answering questions and helping with arrangements such as transportation and appointments.
"About seven to 10 days after someone is discharged from the hospital, they go to Bridge Clinic and a specially trained nurse practitioner and educator and a pharmacist have discussions with patients and caregivers," Gregory says. A multispecialty team, including radiologists, pathologists, ED physicians, as well as counselors, an internal medicine physician, and a neurosurgeon, is involved in program planning.
The best use of the Bridge is to provide clarity of information for patients, who are often confused while in the hospital because of the sheer volume of information they receive, she says.
"Clearly, there's a distinct difference for patients who are in Bridge and for patients who are in the hospital right after a stroke," Gregory says. "In the hospital, they get so much information, and it's really difficult to wrap your head around all of it.
"While we created a bridge between the hospital and outpatient," Gregory adds. "We don't replace the family doctor. We partner with them. We want to ensure that patients have everything they need, because they are still at risk for having another event. There has to be an understanding about the medications they need, about their need to make their appointments."
Challenges to patients are mirrored by challenges to hospitals that are likely to see a rising tide of stroke patients needing care with the aging population. How they organize to meet this influx will be a decision that can save lives and elevate the reputations of their institution.
This article appears in the November 2012 issue of HealthLeaders magazine.