Ways to fundamentally improve stroke care
"The patient experience is fundamental to the success of a value-based healthcare concept"
- Debbie Slye MN, RN, Global Clinical Lead
How to find and influence factors that impact patient outcomes in Stroke? This question becomes more relevant as healthcare institutes across the world have the ambition to move to value-based healthcare. The patient experience is fundamental to the success of a value-based healthcare concept because the value is measured by achieving outcomes that matter to the patient. This is especially important in stroke care when you consider that how a stroke influences a patient’s quality of life may be as important as saving a patient’s life. A measurement like your door-to-needle or door-to-thrombectomy time is a key indicator in a stroke event. But although that is an extremely important indicator, looking at that parameter alone may cause us to overlook other factors in the continuum that influence patient outcomes that matter to the patient. The value for the patient is created over the full cycle of care – during their experience in the pre-hospital phase, throughout their time in a hospital, as they prepare to go home and during their recovery period at home. It will be measured by how a patient perceives their care and how they perceive the organization and provider’s ability to prepare them and their family for each phase of their condition. Care for a medical condition involves multiple care providers, specialties and interventions. The stroke patient’s journey typically crosses borders of many different healthcare entities who don’t necessarily work collaboratively towards a seamless patient experience.
Our approach
Our experience flow mapping technique provides a valuable tool for healthcare teams to see and understand the day-to-day reality of patients and staff as well as to oversee complex care processes to improve. We use the technique to create an entire careflow that places clinical metrics along the entire care continuum - where the data is being collected and how the data can be used to influence care decisions and track performance according to quality standards.
Overview and detailed view It is a fine balance with such a careflow process to make the visualization detailed enough so that it is clinically complete, but avoid making it too complex. A good careflow can really magnify high level gaps and inconstancies in transitions of care but also highlight those detailed issues that really impact staff, patient and family experience and overall quality of care. Get up and engage At the end of the day the most important thing that we do is engage side-by-side with stakeholders across the continuum. By visualizing the steps, the insights, the personal quotes and information on a one coordinated medium – a wall poster really invites stakeholders to stand up and look at the situation and engage each other. It helps people accept the information, feel comfortable with it and endorse it. New innovations on the front and back-end Another aspect we always take into account in supporting care providers to become stroke centers of excellence is to look at possible new innovations. A critical aspect in stroke care is to get patients to the right care from the outset. If you can predict in the field which patient is most likely to benefit from neuro thrombectomy, for example, and send that patient as quickly as possible to the facility with those capabilities, there is a real opportunity influencing patient outcomes in a positive way. And on the back end, we often see in our practice that a focus on rehab can get stalled following the hyperacute phase. Patients often remain in the hospital until a place for them comes available in a dedicated stroke rehab center – thus occupying a costlier bed than clinically necessary. Using predictive analytics to plan ahead for which follow up treatment might be most relevant combined with an earlier assessment of patient and family’s wishes to make transitions of care more seamless and less costly.
Teamwork The hallmark of excellence in stroke care is teamwork – teamwork requires timely and accurate communication of patient data and events in the care process across multidisciplinary team members.
Critical data collection can get missed in the flurry to diagnose and treat the patient. Electronic tools to automatically capture, filter, consolidate and disseminate information to the key team members gets everyone on the same page. These tools and displays of information help focus the staff on the most relevant information surrounding this patient’s needs and guide them toward the best treatment options.
About the author
Debbie Slye, MN, RN, ExO Global Lead, Healthcare Operations & Clinical Transformation
Debbie and her team help healthcare organizations drive sustainable transformation by empowering staff to balance demands for patient access, to manage throughput across the enterprise, and to optimize overall clinical and financial outcomes. Using a people-centered and data-driven approach Debbie supports customers to synthesize the results in the current state, envision a future and develop a realistic roadmap to achieve operational and clinical excellence.
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