Author: Debbie Roper, RN, MSN (d.r. Stroke) Vice President of
Roper Resources, Inc. [email protected] 214-864-8993
Stroke Coordinator: ROI
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Disclosure Debbie Roper is a speaker for: Genentech Activase
Chiesi - Nicardipine Debbie has no actual or potential conflict of
interest in relation to this presentation.
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Stroke Program Development Course (Six Month Recipe) Mock
Stroke Surveys Certification Consulting Services Stroke Consulting
Services Red Gate Inn, McKinney, TX Redgateinn.com
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Objectives 1.Discuss the role of stroke coordinator on
increasing in- patient stroke volumes 2.Discuss impact of
decreasing length of stay on ROI 3.Understand the value of
increasing Activase treatment rates 4.Rationalize the direct cost
incurred for the role of a full time stroke coordinator.
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Cost increase predictions from 2012-2030 Total direct annual
stroke related medical costs expected to increase from $71.55
billion to $183.13 billion Real indirect annual costs projected to
rise from $33.65 billion to $56.54 billion Overall annual costs of
stroke projected to increase to $240.67 billion by 2030 (129%
increase) Stroke 2013; 44: 2361-2375
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Aging population = Increase in prevalence of stroke Additional
3.4 million people with stroke in 2030 By 2030 nearly 4% of the US
population is projected to have had a stroke Stroke 2013; 44:
2361-2375
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Revised & Updated Recommendations for the Establishment of
PSCs A Summary Statement From the Brain Attack Coalition Less
disability associated with use of rt-PA Use of rt-PA increased in
PSCs Less disability = less lifetime cost Stroke units (Class I,
Level A) 17-28% reduction in death 7% increase in being able to
live at home 8% reduction in length of stay 19% increase in good
outcomes Stroke. 2011;(42): 2651-2665
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Stroke Coordinator Role Commander Chief Educator Motivator Data
Abstractor Data Analyzer Speaker Organizer Facilitator Detective
Data Analyst
What does a SUCCESSFUL Stroke Coordinator look Like?
Achieved/Maintained Stroke Certification? No Recommendations for
improvement on stroke survey? Longevity in stroke coordinator
position? Stroke Core Measures are 100%
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Four Elements of a Successful Stroke Coordinator Stroke Volumes
Stroke Treatments Stroke Outcomes Stroke Length of Stays
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Increase Stroke Volume
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What does success look like? Volume of In-Patient Strokes
Yahoo! a steady increase in stroke volume What About? Mode of
Arrival (EMS vs Pvt Vehicle) Arrival within time window for stroke
treatments Inter-facility Transfers Denials Potential leakage to
the competition
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Stroke Patient Mode of Arrival Ambulance Automobile Total
Percent EMS Volumes by Provider ?
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EMS 1 EMS 2 EMS 3EMS 4 Main EMS Providers What does Success
Look Like? EMS volume increases EMS is a participant on stroke
committee EMS stroke protocols are reviewed annually EMS stroke
protocols follow current CPGs EMS run sheets are provided on every
patient Care provided by EMS is assessed to ensure protocol
adherence EMS Feedback is provided by stroke center EMS attends
stroke survey
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Time of Arrival from LKN Acute vs Subacute What does Success
Look Like? Community education events increase (> 2/yr) Largest
Employer Zip code origin Acute stroke volume increases < 3 hours
from LKN 3 - 4.5 hours from LKN < 6/8 hours from LKN
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Increase Stroke Treatments
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What does Success Look Like? ED Physicians find a reason to
treat with IV Activase Every acute stroke patient is screened for
stroke treatments IV/IA Activase Thrombectomy Devices
Clipping/Coiling Carotid Stents Intracranial Stents Percent of all
Ischemic stroke patients who receive IV Activase increases (not
just acute)
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Are Your ED Physicians Finding a Reason to TREAT or NOT TO
TREAT? What does Success Look Like? No missed opportunities ED
Physicians discuss their concerns r/t Activase ED Physicians
prescribe Activase without Neurologist Individual ED Physician
Report Cards Increase number of patients receiving IV Activase
Created by Genesis Lewis RN, BSN Dallas, Texas
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Are You Screening Every Acute Stroke Patient for Eligibility
for Endovascular Treatments? What does Success Look Like? Transfer
agreement with CSC CSC provides all PSC and ASR facilities with
screening criteria LKN is < 6hrs NIHSS > 8/10 or higher NIHSS
< 4 with aphasia CTA = large vessel infarct Every Activase
patient is screened for Thrombectomy prior to admission to ICU All
ED Practitioners are knowledgeable about CSC screening
criteria
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Collaborate with EMS PSC vs CSC for Stroke Treatments What does
Success Look Like? State EMS transfer protocols - CSC vs PSC EMS
screen from scene for PSC vs CSC EMS participate in IRB studies to
validate screening
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Improve Stroke Outcomes
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How Do You Measures Stroke Outcomes? What does Success Look
Like? Patient Disposition increase of patient discharged to home
and/or rehab Compare Initial and Discharge NIHSS decrease in NIHSS
or return to baseline at discharge mRS at 90 days able to perform
activities of daily living No Stroke readmissions within 30
days
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Dont forget the financial impact of improved outcomes Calculate
complication rates (pneumonia 3%) Calculate cost/case of
complication rates Pneumonia, DVT, PE (Increase of $33,155)
Effective dysphagia screening at bedside can reduce aspiration
pneumonia by 50% (Hinchey, et al. Stroke 2005;36) 3% of 340= 10.2
patients with pneumonia ($338,181) 50% reduction = $169,090 in cost
avoidance
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Decrease Length of Stay
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The DRG system is in place to incentivize hospital efficiency
Strategies for decreasing cost revolve largely around the formation
of stroke units Savings of ~$55 million per 1000 patients Stroke
2012; 43: 1131-1133
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Decrease Length of Stay (Ischemic, Hemorrhagic, TIA) What does
Success Look Like? Ischemic stroke LOS = Hemorrhagic stroke LOS TIA
LOS
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A Successful Stroke Coordinators ROI Using Four Elements Stroke
Volumes Increase Year over Year Stroke Treatments Increase Stroke
Outcomes Improve Stroke Length of Stays Decrease