Quality Improvement in Acute Stroke Care: A TeleNeurologist’s Perspective
We all know that time is brain when it comes to stroke care. Every second that passes during an acute stroke is critical in determining a patient’s short – and long-term health, and efficiency and skill in acute ischemic stroke (AIS) treatment have direct and measurable patient benefits. Developing efficiency in AIS care means identifying delays in treatment and following best practices to create opportunities for improvement. Efficiency in AIS treatment also relies on expert teamwork, from the on-screen neurologist to the on-site stroke staff.
Telemedicine has become the standard of treatment in AIS care, permits faster physician response times, and maximizes physician resources during stroke treatment and thrombolytic administration. The increasing prevalence of telemedicine in healthcare positions neurologists at the crux of AIS treatment, and the on-screen neurologist’s expertise is essential in ensuring that acute stroke care is executed seamlessly.
How do you improve stroke care outcomes for your patients and facilities?
Enter quality improvement. Quality improvement is a process that ensures better patient care and improves metrics for facilities by decreasing key treatment times to match industry standards. This, along with best practices, will demonstrably enhance patient outcomes.
What is Quality Improvement?
Quality improvement is a framework used to improve patient care and standardize processes. It reduces variation, achieves predictable results, and improves outcomes for patients, healthcare systems, and organizations.
What will implementing Quality Improvement for acute stroke treatment mean for facilities?
The most important goal of quality improvement in treating AIS is reducing door-to-needle (DTN) times (for thrombolysis) and door-to-groin (DTG) puncture times (for thrombectomy). The American Heart Association recommends DTN times less than 60 minutes and DTG puncture times less than 90 minutes. Since some patients who undergo thrombectomy will first receive a thrombolytic, delays in DTN times can also result in delays in DTG times. Ultimately, reducing DTN times can improve outcomes for all acute stroke treatments.
Quality improvement focuses first on improving facilities’ DTN and DTG times. Improving these two simple stroke care metrics has widespread effects on improving stroke care in general, from increased efficiencies in the emergency department to improved downstream nursing, rehabilitation, and stroke prevention outcomes. The American Heart Association provides best practice recommendations that complement quality improvement processes for reducing DTN and DTG times.
Best Practices for the On-Screen Neurologist
Ensuring the best outcomes for AIS treatment requires a combination of quality improvement processes and teamwork from all care team members. During a stroke alert, the on-screen neurologist should lead the care team by facilitating treatment given quickly and safely, guided by clinical expertise, and with attention to critical metrics (DTN and DTG times). The patient’s and family’s experience during acute stroke treatment is also a priority, and the on-screen neurologist must, as much as possible, cultivate an environment that is calm and free of distractions. Interactions between care team members are respectful, and consensus medical advice is represented consistently by physicians and nurses alike.
Our TeleNeurologists Ensure Quality Improvement for Our Partners
As telemedicine has taken a larger and more pivotal role in AIS treatment, the importance of quality improvement has become abundantly clear. By implementing quality improvement processes in our TeleNeurology services, our neurologists streamline patient care and raise the bar for facility metrics, aiming to meet industry standards for treatment times, highlighted by an average physician response time of three minutes. Saving lives is the cornerstone upon which we built a foundation of standardized processes, reduced variations, and improved outcomes that we guarantee our partner hospitals through our transformative telemedicine services. It’s through the combination of quality improvement and dedicated teamwork, led by our TeleNeurologists, that we strive to create an environment where every precious second counts for the betterment of our patients’ lives.