Effective and timely care of the adult patient experiencing stroke symptoms is essential to limit patient morbidity and mortality. Quality care requires collaboration from multidisciplinary team members and adherence to clinical practice guidelines and protocols. Nationally, there is an observed gap in adherence to stroke care standards, especially for stroke alerts that occur in the inpatient setting.1 Despite this observed gap, sparse studies exist describing inpatient adherence to national guidelines and identification of factors associated with non-compliance. Evidence-based national guidelines and facility protocols exist, although the uses of these practice recommendations have not been investigated for the identified population. This study measured adherence to the current national guidelines provided by the AHA and achievement of performance and quality measures defined by Get With The Guidelines®-Stroke (GWTG®-Stroke) and the adherence to the organizational “stroke-alert” protocol. The purpose was to evaluate the current stroke alert patient-care process of already admitted adults and to identify patterns of care and gaps in practice, leading to recommendations for future improvement of inpatient stroke alerts both institutionally and nationally. A retrospective chart review (RCR) was conducted on 78 inpatients with a “stroke-alert” at a rural major academic tertiary-care center. Demographics, stroke symptoms, primary specialty service, unit location, time benchmarks, time of day and many other variables surrounding the stroke alert were collected. Descriptive, univariate and multivariate statistics were calculated. A hospital-wide analysis allowed for: 1) increased knowledge regarding the current clinical practices, 2) identification of practice gaps, and 3) opportunity for process improvement. While this project informs practice, it is even more significant in highlighting barriers to optimize clinical outcomes of admitted patients who suffer from an acute stroke, thereby decreasing morbidity and mortality.
Findings from this study suggest stroke alert accuracy is dependent on patient physical location, primary service and time of day. Time of day and physical location of patient also contributed to significant differences in meeting national guidelines and time benchmarks. No patients assessed in this ten month period met criteria to receive intravenous tissue plasminogen activator (IV-tPA) or interventional thrombectomy at this study location. This may be due to increased comorbidity and complexity of patients who are already admitted to the hospital or high false positive stroke alert rates. Further evaluation is required to assess the particular factors associated with stroke alert inaccuracies and barriers associated with not meeting time benchmarks and clinical practice guidelines.
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