Division CMO Update: Collectively Targeting Stroke

"Our goals can only be reached through a vehicle of a plan, in which we must fervently believe, and upon which we must vigorously act. There is no other route to success."

Words spoken decades ago by one of the most influential artists of the 20th century still hold true today - in personal lives and organizations nationwide. Narrowly focused on the challenge of improving stroke care, "what if" success meant that significantly fewer than 130,000 lives were cut short every year nationwide? What if reaching our collective goal helped more stroke survivors escape brain damage and paralysis as well as emotional and physical pain?

Throughout HCA Healthcare and the Mountain Division, we're aiming to address these questions and successfully improve stroke treatment. Here's how: HCA launched its comprehensive and collaborative Stroke Performance Improvement Initiative in May 2017. Since then, all 14 HCA divisions have been implementing the plan and working toward increasing the percentage of patients who are more promptly treated for a stroke.

National Timeline Issue

Studies have found that fewer than 30 percent of U.S. patients are treated within the evidence-based guideline for door-to-needle (DTN) timelines: 60 minutes or less. That is why HCA developed an initiative that specifically aims to improve the diagnostic process for stroke patients and significantly decrease DTN times whenever appropriate.

To help emergency medicine and stroke care specialists at its hospitals achieve those goals, HCA developed the following "Stroke Alert":

HCA Timeline Goals

1. Rapid assessment of potential stroke patients who present to the ED with neurological significant symptoms within six hours of time last known to be well
2. ED physician assessment within five minutes of patient arrival
3. Neurologist response to the ED via phone within five minutes of the Stroke Alert notification
4. Patient will receive a completed non-contrast head CT with initial interpretation within 20 minutes of arrival
5. Administration of intravenous thrombolytics within 60 minutes of patient arrival in 90 percent of appropriate patients

As you know, the American Heart and Stroke Association encourages DTN times within 60 minutes in 75 percent or more of stroke patients treated with thrombolytics like tPA. However, HCA is upping the ante to achieve that goal for 90 percent of appropriate stroke patients. The Stroke Alert is only one component of HCA’s comprehensive Stroke Performance Improvement Initiative. The plan also features an outline for specialized leadership teams and defined action items as well as multiple resources and tools.

HCA Stroke Performance Improvement Initiative

The goal: ensure that the right components are in place at participating hospitals to drive improvements in stroke care and reduce DTN times. Effectively meeting that goal requires leadership, commitment to a common goal, and collaboration. Therefore, our path to achieving clinical excellence in stroke care is physician led. Our patient-focused approach encourages the dedication and engagement of all involved. HCA, division and hospital performance improvement teams are already hard at work implementing the HCA initiative. Their well-defined roles and designated responsibilities aim to improve the effectiveness of their efforts and ultimately ensure overall success.

• Physician Leader / Neuroscience medical director
• Team Leader / Neuroscience leader
• Team Coordinator / Facilitator / Stroke care program coordinator
• High Performing Clinical Team Members

While having a plan is essential to success, taking action gets the job done. Here is a list of additional tools and resources that our teams are implementing to improve stroke care:

• Comprehensive playbook
• Clinical practice guidelines
• High performing clinical team roles and responsibilities
• Physician engagement assessment
• Tips to improve DTN time
• Tips to improve stroke care performance
• Stroke alert nursing checklist
• DTN patient tracker

Additionally, these action items clearly identify our path to success:

• Identify opportunities for large scale improvement
• Assess the leadership (i.e. physician and management), structure and overall processes for quality improvement
• Develop strategies to improve patient care
• Utilize core measures, HCA Comprehensive Health Outcome Information System (CHOIS) Stroke Discovery Dashboard
• Utilize facility-level data when performing operational and quality assessments at the various organizational levels
• Perform service line development assessments
• Create and deploy quality improvement tools and resources
• Create and deploy tools to improve documentation

I hope this information has increased your confidence in our ability to take great care of your patients, should they experience a stroke. If you’re in the position to support one of our stroke performance improvement teams in any way, I encourage you to do so!

For more information or if you have questions, contact Dr. Mike Baumann, Mountain Division CMO: Michael.Baumann@HCAhealthcare.com