Background:
Each year approximately 795,000 persons in the United States experience a stroke. Data from the Paul Coverdell National Acute Stroke Registry suggest many acute stroke patients do not receive treatment according to established guidelines. Stroke units have been shown to save lives, reduce dependency, and increase the chance of returning home. Our aim was to establish if stroke care improved through the institution of a standardized care program via a hospitalistled multidisciplinary stroke team with mandatory neurology and PM&R consultation. With the impetus to reduce errors, improve communication, and provide appropriate care, hospitalists face immense challenges to give the best care at maximum efficiency and safety. Multidisciplinary teams that exclusively manage stroke patients in a dedicated ward may positively affect and standardize care. We sought to improve communication, patient care, and patient satisfaction through team rounding with nursing, case managers, and mandatory consultation with neurology and PM&R.
Methods:
Prior to implementation of the team, administrative data were collected prein‐tervention as baseline. Patients were comanaged on a dedicated stroke unit with a stroke coordinator responsible for cohorting patients and data collection. Guidelines were established for quick turnaround of consults and investigations. Data review was performed at monthly stroke performance improvement meetings cochaired by a hospitalist and a neurologist. Any core measure misses were analyzed and discussed, with action plans implemented.
Results:
Data pre‐ and postimplementation of the multidisciplinary team with mandatory consultation were collected for all stroke patients and are reported here for the period 2007–2009. The average length of stay was 5.68 days prestudy compared with 5.43 days poststudy. The core measures before and after were: use of a lipid lowering agent increased from 68% to 75%, antiplatelet agent use increased from 92% to 96%, and lipid profile evaluation increased from 68% to 72%, respectively. Utilization was also assessed; the number of CT scans ordered did increase, from 94% pre to 98% after, as did the number of MRIs ordered, from 74% to 77% of cases poststudy. Discharge home with self‐care increased from 32% to 42% in the first year but then dropped to 34%. The average total cost per case decreased from $9396 prestudy to $9028 poststudy at the end of year 2. Mortality and readmissions did not change.
Conclusions:
Our data show a multidisci‐plinary team approach to be effective. We saw a reduction in length of stay, with an overall decrease in cost per case. Coordinated care improved compliance of core measures, but ongoing analysis and interventions are needed to maintain this. Mandatory use of specialists, as expected, increased utilization; however, it did not negatively affect cost. With emphasis on accountable care organizations in the near future, refining coordinated disease specific care is critical to providing cost‐effective care.
Disclosures:
S. Yadav ‐ none; J. Fitzgerald ‐ none; B. Niemiciec ‐ none; R. Hayden ‐ none; F. Leming ‐ none; R. Sittig ‐ none; C. Armon ‐ none; B. Rodstein ‐ none; E. Benjamin ‐ none