The first year of the program was associated with improvements in quality metrics across most areas of stroke care. Notably, 11 quality indicators that assess direct patient care measures have improved significantly from prior to program initiation in 2012 to after implementation of a comprehensive stroke care program at the conclusion of 2013. Those measures that were not already at goal of ≥ 85% achievement showed the most dramatic improvements (Figure 3).
Goals and Future Planning
The work of the DVAMC Stroke Program is far from over. Progress made is easily lost without continual monitoring and feedback. Challenges continue as well. Goals moving forward include improving door-to-needle times for IV alteplase therapy, more consistently performing swallow screens prior to oral intake, more consistently providing patient education, and increasing engagement with PCPs and the veteran community in providing stroke education and risk reduction.
A larger goal for future planning for the DVAMC is the need for a designated stroke care unit. Currently, stroke patients are admitted to the Critical Care Unit (CCU) for initial monitoring and treatment and when stable are moved to general medical wards. In some instances, this necessitates that the less acute patients occupy a CCU bed due to ward nursing limitations (ie, neuro checks every 2-hours is too great of a time demand for the ward nurses) or that the more neurologic acute patients are transferred to general medical wards when they would benefit from a more neurology-focused therapeutic environment. Stroke unit care has been associated with improved patient outcomes compared with care on general medical wards.11 The development of a designated stroke care unit is a long-range goal of the program.
Conclusion
The development of the Stroke Program, including an SPC, has improved the care of veterans with stroke at the DVAMC. The achievements of the DVAMC Stroke Program are the result of coordinated efforts of a team of dedicated health care professionals from all disciplines who sought to improve stroke care for veterans. The DVAMC continues to strive toward ever-improving outcomes, working with community partners and challenging itself to achieve a higher level of excellence. The lessons learned at the DVAMC may serve as a model for other VHA hospitals seeking to improve their stroke-related care programs.
Acknowledgements
The authors thank the executive leadership team and the chief of medicine of the DVAMC who recognized the need and potential for better stroke coordination and who have been fully supportive of the authors’ efforts to improve coordination, education, and care of their patients with strokes.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
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