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December 10, 2008 > Stroke Program Holds Itself to Higher Standards

Stroke Program Holds Itself to Higher Standards

Patients Benefit from Program's Continuous Strive for Improvement

Washington Hospital has received the American Stroke Association's (ASA) Get With The GuidelinesSM-Stroke (GWTG-Stroke) Bronze Performance Achievement Award, which recognizes the hospital's commitment and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations.

To achieve the award, Washington Hospital's Stroke Program was required to track data to prove the program was consistently meeting measures approved by the American Stroke Association.

"These measures that we're striving for are all about the national practice guidelines," says Doug Van Houten, R.N., clinical coordinator for the Stroke Program at Washington Hospital. "These aren't something one person just came up with. These standards are all based on thousands and thousands of journal articles from 20 to 30 of the industry's biggest players - the big names in stroke care - which have become practice guidelines."

When it comes to stroke care, there is always room for improvement, Van Houten says. That's why Washington Hospital's leadership and the Stroke Program's staff are always looking for new ways to hold themselves to a higher standard of care.
"One of the key points of a stroke program is continuous quality improvement," he says. "There are always things that need to be a little better."

Asked why he volunteered to become the champion of the ASA's Get With The Guidelines program at Washington Hospital, Van Houten says the program's goals represent what is best for stroke patients. The program is not mandatory and the hospital doesn't receive any compensation for meeting the guidelines; it's simply good practice, he says.

"It's about accountability," Van Houten explains. "I think consumers are pretty savvy, particularly in health care. They want to go to a good provider. By achieving standards like these, we demonstrate to patients that we're worthy of their trust in coming to us. We have practices in place to treat patients from an evidence-based process. In the long run, you're going to do better if you come here."

Stroke remains the No. 3 killer in the United States and is the leading cause of long-term disability, which makes the importance quality stroke care undeniable, according to Van Houten.

The guidelines mandated by the ASA's Get With The Guidelines program are very
specific and are geared toward improving patient outcomes.

Van Houten has tracked data at the hospital for the better part of 2008, ensuring that the Stroke Program has maintained at least an 85 percent compliance rate with the guidelines, which include:
* When appropriate, acute stroke patients arriving in the ER should receive Tissue plasminogen activator (tPA), also known as clot-busting medication, within 180 minutes of symptom onset.
* Ischemic stroke and transient ischemic attack (TIA) patients must receive antithrombotic medication (blood-clot prevention) within 48 hours of admission.
* Upon discharge, ischemic stroke and TIA patients must be discharged on medication approved to reduce the chances of a second stroke.
* Patients suffering from atril fibrillation must be discharged on a regimen of anticoagulation therapy.
* Patients at risk for deep vein thrombosis (DVT) must receive some sort of prevention treatment by second hospital day. For instance, a patient that arrives in the ER after a stroke and is unable to walk unassisted within 48 hours must receive circulation therapy to maintain blood flow and prevent a pulmonary embolism.
* Ischemic stroke and TIA patients with high cholesterol must be prescribed a lipid-reducing agent (statin drugs).
* Any stroke patient admitted that also smokes must receive smoking medication advice or cessation literature.

"It's a dedication to science and evidence-based practice," Van Houten says of the measures. "The proof is in the pudding. If you call yourself a stroke center and you can't meet these demands, then maybe you're not as good a stroke center as you thought. We should be held to certain measures. If strokes are going to be directed to this hospital, we should have the data that says we're worthy."

The Stroke Program is on its way to winning the ASA's silver and gold achievement awards, which are given when a hospital meets the guidelines for 12 consecutive months and two years, respectively.

As champion of the program for Washington Hospital, Van Houten is responsible for tracking the data and identifying areas for improvement.

"We continually collect data, and if the data's good, we look for places where we can make it better," he says. "We have to prove we're meeting standards, and we have to have the desire to constantly improve ourselves. But you have to know what to focus on. We submit data to a lot of different places, including the American Hospital Association and Joint Commission, as well as quarterly data to Alameda County Emergency Medical Services to prove we're doing what we're supposed to be doing as a stroke center."

But at the end of the day, when all the statistics have been tabulated, it comes down improving patients' outcomes, he says.


Stroke care for the community

To learn more about Washington Hospital's Stroke Program, visit www.whhs.com, click on "Services & Programs," select "Taylor McAdam Bell Neuroscience Institute," and choose "Stroke Program" from the drop-down menu.

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