The stroke center at Palm Drive Hospital in Sebastopol, Calif., received a Superior Performance award from the Healthcare Facilities Accreditation Program in May. The hospital is the only facility in California and the second in the country to receive this award, which was launched by HFAP in April. Even more impressive is the fact that Palm Drive Hospital, a 37-bed, non-profit community hospital, began developing the stroke program when the hospital was in bankruptcy. The hospital emerged from bankruptcy in May 2010, at which point it received the Primary Stroke Center designation from HFAP, and then two years later advanced to Superior Performance.
Here, leaders of the stroke program describe how the hospital achieved high stroke performance without access to capital.
To consistently meet stroke care guidelines, Palm Drive created a multidisciplinary stroke committee that is comprised of representatives from all departments and areas involved in stroke care, including the emergency department, radiology, neurology, nursing, quality, education and the community's emergency medical services. The committee meets monthly to assess the hospital's stroke care and ensure stroke services are coordinated.
"We want to treat people through the entire spectrum," says Allan Bernstein, MD, a stroke neurologist and key member of the stroke team. "The program is not just to prevent a stroke, it's educating everybody — patients, families and staff."
Coordinating stroke care
Successful stroke care requires coordinated care between multiple providers, from ED physicians and nurses to radiologists to neurologists. "Achieving primary stroke certification is an example of how these organizations have been able to coordinate multiple services, resources and disciplines necessary to deliver high quality, clinically effective and evidence-based care in a limited window of opportunity to impact the outcome of these patients," says Susan Lautner, RN, BSN, MSHL, CPHQ, accreditation specialist for quality and patient safety at HFAP.
As a small community hospital, Palm Drive can coordinate care between different departments more easily than a larger system could, according to Dr. Bernstein. "One of the characteristics of this small hospital is that people who work here are by definition committed to the success of the hospital," he says. "[Being a] small hospital is to our advantage, because when we [announce] a stroke case, everybody drops what they're doing and comes to take care of the patient. That kind of teamwork is what makes it so effective."
In addition, although a small hospital may not have as much access to on-site specialists as larger institutions, Palm Drive uses telemedicine to connect with a stroke neurologist from California Pacific Medical Center in San Francisco who is available 24/7 to consult on Palm Drive stroke patients.
The dedication of physicians, nurses and other staff to meet stroke care guidelines may be the most important element of high-performing stroke centers — even more important than funds. "This whole process started while our facility was in bankruptcy. It isn't a costly project for our hospital to carry out, but it is one that takes a lot of dedication and commitment to give the best care to patients," says Karen Cauthen, Palm Drive chief nursing officer. "We did it with no money, because we were bankrupt, and we did it really well. Hospitals may struggle, but that doesn't mean quality of care has to suffer."
Coordination challenges
One of the challenges of coordinating services was encouraging collaboration between ED physicians and nurses, according to Dr. Bernstein. The physicians had to learn to allow nurses to take over some processes to speed the delivery of care.
Another challenge was receiving imaging exams within 45 minutes of the patient's arrival — one of the most difficult requirements for hospitals applying for the superior performance award, according to Ms. Lautner. Palm Drive achieved this metric by educating the X-ray department on the importance of getting scan results for stroke patients back quickly. "You have to get the imaging department to agree this is a top priority," Dr. Bernstein says. "Until you get the reading back from the X-ray department, you can't continue the process properly."
Educating within and outside the hospital
Education also plays a major role in Palm Drive's stroke care performance. Besides educating people on the severity of stroke and the importance of a rapid response, the hospital also educates staff on new processes to help speed care. For example, the hospital trained staff to turn the CT machine on and move the patient to the CT table because the CT technicians are not at the hospital at night. By learning this skill, staff are able to prepare the patient for when the CT tech arrives.
HFAP's superior performance stroke award also requires the core stroke team to have at least eight hours of continuing education in stroke care annually. Palm Drive provides additional educational opportunities throughout the year to help the team practice appropriate responses. "One of the most important things is practice," says Rebecca Monroe, the education coordinator at the hospital. "Practice, evaluate the process, change the process in ways it needs to be changed and practice it again."
Teaching the community about stroke care
Equally important as educating hospital providers about stroke is educating the community, including other local hospitals and EMS staff. For instance, Palm Drive's hospital chief of staff, director of the ED and member of the stroke committee, Jorge Gonzalez, MD, has presented educational programs to paramedics and other EMS providers so they know to bring stroke patients to the closest stroke center. ED physicians also meet regularly with EMS providers for continuing education programs.
In addition, Palm Drive is working with other hospitals to help them develop stroke programs to increase patients' access to stroke center-certified hospitals. One of the purposes of the Superior Performance award is to motivate other hospitals and accreditors to look more closely at stroke care. "We believe we can encourage other healthcare organizations to evaluate their level of clinical response to this terrible disease," Ms. Lautner says.
Healthcare Data Guides Tri-City Medical Center's Decisions in Quest for Top Quality
Leveraging Technology to Collaborate With the Community on Reducing Readmissions
Here, leaders of the stroke program describe how the hospital achieved high stroke performance without access to capital.
Building a superior stroke program: The basics
The Superior Performance award recognizes HFAP-designated Primary Stroke Centers that have met 14 clinical indicators at the 95th percentile for at least three consecutive quarters. Some of these indicators include stroke team arrival within 15 minutes of patient presentation, lab studies completed within 45 minutes of patient presentation and administration of statins to patients at discharge.To consistently meet stroke care guidelines, Palm Drive created a multidisciplinary stroke committee that is comprised of representatives from all departments and areas involved in stroke care, including the emergency department, radiology, neurology, nursing, quality, education and the community's emergency medical services. The committee meets monthly to assess the hospital's stroke care and ensure stroke services are coordinated.
"We want to treat people through the entire spectrum," says Allan Bernstein, MD, a stroke neurologist and key member of the stroke team. "The program is not just to prevent a stroke, it's educating everybody — patients, families and staff."
Coordinating stroke care
Successful stroke care requires coordinated care between multiple providers, from ED physicians and nurses to radiologists to neurologists. "Achieving primary stroke certification is an example of how these organizations have been able to coordinate multiple services, resources and disciplines necessary to deliver high quality, clinically effective and evidence-based care in a limited window of opportunity to impact the outcome of these patients," says Susan Lautner, RN, BSN, MSHL, CPHQ, accreditation specialist for quality and patient safety at HFAP.
As a small community hospital, Palm Drive can coordinate care between different departments more easily than a larger system could, according to Dr. Bernstein. "One of the characteristics of this small hospital is that people who work here are by definition committed to the success of the hospital," he says. "[Being a] small hospital is to our advantage, because when we [announce] a stroke case, everybody drops what they're doing and comes to take care of the patient. That kind of teamwork is what makes it so effective."
In addition, although a small hospital may not have as much access to on-site specialists as larger institutions, Palm Drive uses telemedicine to connect with a stroke neurologist from California Pacific Medical Center in San Francisco who is available 24/7 to consult on Palm Drive stroke patients.
The dedication of physicians, nurses and other staff to meet stroke care guidelines may be the most important element of high-performing stroke centers — even more important than funds. "This whole process started while our facility was in bankruptcy. It isn't a costly project for our hospital to carry out, but it is one that takes a lot of dedication and commitment to give the best care to patients," says Karen Cauthen, Palm Drive chief nursing officer. "We did it with no money, because we were bankrupt, and we did it really well. Hospitals may struggle, but that doesn't mean quality of care has to suffer."
Coordination challenges
One of the challenges of coordinating services was encouraging collaboration between ED physicians and nurses, according to Dr. Bernstein. The physicians had to learn to allow nurses to take over some processes to speed the delivery of care.
Another challenge was receiving imaging exams within 45 minutes of the patient's arrival — one of the most difficult requirements for hospitals applying for the superior performance award, according to Ms. Lautner. Palm Drive achieved this metric by educating the X-ray department on the importance of getting scan results for stroke patients back quickly. "You have to get the imaging department to agree this is a top priority," Dr. Bernstein says. "Until you get the reading back from the X-ray department, you can't continue the process properly."
Educating within and outside the hospital
Education also plays a major role in Palm Drive's stroke care performance. Besides educating people on the severity of stroke and the importance of a rapid response, the hospital also educates staff on new processes to help speed care. For example, the hospital trained staff to turn the CT machine on and move the patient to the CT table because the CT technicians are not at the hospital at night. By learning this skill, staff are able to prepare the patient for when the CT tech arrives.
HFAP's superior performance stroke award also requires the core stroke team to have at least eight hours of continuing education in stroke care annually. Palm Drive provides additional educational opportunities throughout the year to help the team practice appropriate responses. "One of the most important things is practice," says Rebecca Monroe, the education coordinator at the hospital. "Practice, evaluate the process, change the process in ways it needs to be changed and practice it again."
Teaching the community about stroke care
Equally important as educating hospital providers about stroke is educating the community, including other local hospitals and EMS staff. For instance, Palm Drive's hospital chief of staff, director of the ED and member of the stroke committee, Jorge Gonzalez, MD, has presented educational programs to paramedics and other EMS providers so they know to bring stroke patients to the closest stroke center. ED physicians also meet regularly with EMS providers for continuing education programs.
In addition, Palm Drive is working with other hospitals to help them develop stroke programs to increase patients' access to stroke center-certified hospitals. One of the purposes of the Superior Performance award is to motivate other hospitals and accreditors to look more closely at stroke care. "We believe we can encourage other healthcare organizations to evaluate their level of clinical response to this terrible disease," Ms. Lautner says.
More Articles on Hospital Quality:
IOM: 10 Recommendations to Create a Continuously Learning Healthcare SystemHealthcare Data Guides Tri-City Medical Center's Decisions in Quest for Top Quality
Leveraging Technology to Collaborate With the Community on Reducing Readmissions