A recently unveiled program to improve the outcomes of ischemic stroke patients at Stanford Hospital has brought home two key messages for David Tong, MD, assistant professor of neurology, who helped spearhead the effort.

First, elements of good care — such as preventive measures and patient education — can affect patient outcomes as significantly as dramatic, high-tech interventions. Second, efforts to improve patient care yield the best results when several disciplines work together, maintaining frequent, open communication.

"We’ve seen that if you work with the hospital staff as a group, you can create an integrated system that works really well," said Tong, co-chair of the team that created the "Saving Our Strokes" program as a quality-improvement project. "When people are cooperative and focused on a common goal, it’s relatively easy to accomplish."

Joan Caldwell and David Tong display their presentation on improving stroke treatment at Stanford Hospital. Their project lays out specific steps that staff can follow to reduce complications and patient readmissions. The participants hope that the program serves as a model for hospital teamwork.
PHOTO: SARA SELIS

The program emphasizes key strategies that have been found effective for ischemic stroke patients. They include making sure the patient gets out of bed and moving within 48 hours of the stroke; removing the patient’s catheter within 48 hours; providing smoking-cessation counseling to those who need it; providing education on proper diet and exercise; and prescribing an anticoagulant for patients with an abnormal heartbeat.

The project originated last spring when Tong — associate director of the Stanford Stroke Center and the quality-improvement chair for the neurology department — was reviewing benchmarking data from the University HealthSystem Consortium on stroke outcomes.

While Stanford consistently performs among the nation’s best in the acute management of stroke, Tong explained, he still saw room for improvement in the post-acute phase.

With help from the Quality Improvement Department, Tong convened a 13-person team to develop a program that would improve stroke outcomes, thereby reducing complications and readmissions.

What made the effort work, Tong said, was strong collaboration among multiple disciplines. The team included nursing, nutrition, occupational therapy, physical therapy, pharmacy and social work. "The multidisciplinary aspect was incredibly valuable," he said. "We’d sit together and discuss the best ways to achieve our goals."

Pat Smith, a quality manager participating in the effort, called it "one of the best teams I’ve seen at Stanford. Everyone worked together for the patient’s benefit."

The plan, which took six months to finalize, involved changes in documentation as well as patient care. The team revised the standard order set in the physician order entry system to include all elements of the plan, for example, and it created an easy-to-use discharge checklist for nursing staff.

"Saving Our Strokes" was unveiled in early October with a kickoff luncheon for neurology physicians and Unit F3 staff, and in-service training for all unit staff who care for stroke patients. Results will be monitored through periodic chart reviews. Once the program is evaluated, it will be expanded to other units that care for stroke patients.

"The interdisciplinary model works very well, and we want to encourage participation in these efforts," said Joan Caldwell, unit F3 nurse manager, who served on the Saving Our Strokes team. "This is a model we’d like to see implemented at every service in the hospital."

Tong said the program’s successful creation and implementation has been driven by the efforts of participating hospital staff. And he said the project underscores the importance of basic strategies like patient education and preventive measures. "Making sure the patient is on anti-platelet medication and receives smoking-cessation counseling — those things aren’t sexy, but they may really affect the long-term outcome."