GOT DATA! NOW WHAT?
Angela Overton MSN, RN, CNRN
Quality Care Reviewer-Stroke
Clinical Quality, Safety & Performance Improvement
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
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 %
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?
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!
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 [email protected]
v Terri Hamm- Mercy Des Moines 515.358.0048 [email protected]
v Jennifer Thoe- North Iowa Mason City 641.422.7109 [email protected]
v Susan Fowler- Great River Burlington 319.768.1509 [email protected]
v Angela Overton-University of Iowa 319.384.8234 [email protected]