Mission Hospital examined the outcomes of stroke patients admitted between 2002-2003 and found a 5.9% mortality, 14% failure to rescue, and a 2.2% incidence of aspiration pneumonia in acute ischemic stroke patients. The mortality rate was higher at Mission when compared to similar non-teaching community hospitals with the top-quartile hospitals mortality rates at 3.7%. Mission was challenged to evaluate their care practices and clinical outcomes of this high-risk group.

Motivated by the new practice recommendations and potential for impacting patient outcomes, neuro services formed a multidisciplinary team to begin the process of performance improvement. Patient management practices were examined and relevant research evaluated. Baseline data was measured using the JCAHO measures and a data base measuring the incidence of aspiration pneumonia and mortality. The team melded national guidelines and supporting literature into hospital based protocols. Personnel from all disciplines including rehab were integrated into care processes with early consultation with rehab within 24 hours of patient admission. Prospective data was collected and care patterns analyzed. Two stroke protocols were implemented in January 2005. Outcome statistics gathered in early 2006 revealed: mortality 2.3%, 0% failure to rescue, and aspiration pneumonia 0.02%. The JCAHO measures revealed increased compliance with all ten when compared to the initial baseline statistics.

This presentation will utilize a performance improvement approach revealing the actions used by the team to apply evidence based guidelines and literature to the clinical setting. Statistical analysis will provide outcome data emphasizing the positive aspects of applying evidence based guidelines/literature to practice.