Once the Department of Health received funding for the State Stroke Program, they approached the Critical Access Hospital (CAH) Quality Network, a program of the UND Center for Rural Health, and requested a partnership that would use the CAH Quality Network’s expertise to raise awareness and help gain participation in the program. The Center hired Nikki Massmann as a State Stroke Program coordinator to help hospitals “on-board,” or become familiar with the online stroke registry, provide practical assistance to the hospitals as needed, and find good sources of education and information. The CAH Quality Network was already working with the small rural hospitals of the state on other quality improvement initiatives, so adding this program was a good fit for both entities. Since Massmann began working with the State Stroke Program in 2010, 28 of the 36 critical access hospitals and all of the larger, tertiary hospitals in North Dakota have been on-boarded and are participating. Massmann said, “The program is more than chart entry into a benchmarking tool. Hospitals that participate have learned about the quality of care they are giving to stroke patients and are using what they have learned to focus on care improvement. The most impressive part is how the urban and rural hospitals are working together to implement quality improvement and guide each other through the process of change. They have all been so willing to share knowledge and successes on stroke care improvements, which benefits the ultimate focus of the program, the patient.” Hospitals participating in the program receive a grant to purchase the Web-based Patient Management Tool, into which they enter nonidentifiable stroke case information. For large facilities in the state, such as Altru or Medcenter One, 30 consecutive cases are entered as an initial entry to establish a baseline; critical access hospitals enter one year’s worth of cases for their initial entry. All hospitals will continue to annually enter data to help measure against the baseline; these respective numbers are
Nicole Massman what the hospitals are asked to record. From the data entered, a benchmark, or line of quality, is created for measures such as the percentage of patients with a history of smoking who are, or whose caregivers are, given smoking-cessation advice or counseling during their hospital stay; the percentage of patients who are treated within 60 minutes of their emergency department arrival; and how patients arrived at the hospital. Ultimately, the program’s goal is for all hospitals, physicians, emergency medical services, and communities to speak the same language. The topic of stroke care has been brought to the forefront, and North Dakota hospitals large and small will continue to implement the State Stroke Program, sharing best practices with one another to provide the best care possible to every stroke patient. With this dedicated work and collaboration, when the unfortunate incident of a stroke occurs, patients in North Dakota can expect the best quality of care wherever they are.
Know the symptoms of a stroke F — Facial Weakness A — Arm and Leg Weakness S — Speech Problems T — is for Time. Call 911 right away.
NORTH DAKOTA MEDICINE Spring 2012
North Dakota Medicine Spring 2012