CCM: Improving ED STROKE / TIA Care Collaborative

1. CCM: Improving ED STROKE / TIA Care Collaborative Information Call May 6 & 16, 2011

2. Outline • Introductions • Overview of CCM • Stroke & TIA 3-year Journey • Focus on the Emergency Department • Collaborative Key Dates • How the Collaborative will support your site’s CCM Stroke & TIA work? • Enrollment and Next Steps

3. Introductions Dr. Devin Harris Clinical Lead Stroke & TIA Noreen Kamal Quality leader Rebecca Brooke Project Coordinator, CCM

4. Your Turn

5. Clinical Care Management - Vision To improve the quality of patient care in BC through a well-supported system-wide approach to establishing, promoting implementation of, and reporting out on evidence-based clinical best practices.

6. CCM Stroke & TIA Improvement a 3- Year Journey Phase 1 Phase 2 Phase 3

7. Phase 1 of the CCM Implementation Support Care in the Emergency Department Collaborative • Working at multiple levels but with a primary focus on: • Supporting changes and improvements in ED care • Strategies to engage front-line care providers • Accelerated change management to meet goal of demonstrated improvement • A Breakthrough Series Collaborative (based upon methods designed by Institute for Healthcare Improvement)

8. Current situation and Gaps in EMS and ED Care • The functional capacity and associated role designations of facilities/hospitals with respect to stroke care are not always clearly understood • EMS bypass protocols are inconsistently available or partially applied • Some regions have specific stroke protocols while others use general guidelines • The implementation of stroke protocols needs to be supported, such that stroke care is standardized • Proper referral to secondary prevention clinics need to occur in the ED for TIA patients

9. CCM Stroke & TIA Collaborative: Primary Goals Reduce the percent of patients who die in hospital or are admitted to a long-term care facility after being admitted / discharged (principal diagnosis) for ischemic stroke. Increase the percent of all ischaemic stroke patients that receive tPA thrombolytic therapy by 2% across the province; Increase the percent of patients with TIA who are investigated and discharged from the emergency department and referred to organized secondary prevention services (including emergency department secondary prevention functions) to 80%; Increase the percent of patients with TIA who are investigated and discharged from the emergency department and seen by organized secondary prevention services within 48 hours from symptom onset, to 60% across the province;

10. CCM Stroke & TIA Collaborative: Secondary Goals Increase the percent of all thrombolysed ischemic stroke patients who receive acute thrombolytic therapy within one hour of hospital arrival to 80%; Increase the percent of patients with suspected acute stroke & TIA who have their blood glucose concentration checked on arrival to the emergency department to 95%; Increase the percent of patients with suspected acute stroke & TIA who have an electrocardiogram performed in the emergency department to 95%; Increase the percent of patients with suspected acute stroke & TIA who are given at least 160 mg of acetylsalicylic acid (ASA) or other antiplatelet agent in the emergency department, unless contraindicated, to 80%; Increase the percent of patients with suspected acute stroke who are mobilized within 24 hours of stroke symptom onset, unless contraindicated, to 85%;

11. CCM Stroke & TIA Collaborative: Secondary Goals Increase the percent of patients with suspected acute stroke who receive an initial dysphagia screen (swallowing screen) within 24 hours of stroke symptom onset, where appropriate, to 80%; Increase the percent of patients with suspected acute stroke & TIA who have vascular imaging of the carotid and vertebral arteries within 24 hours of symptom onset (unless the patient is clearly not a candidate for revascularization), to 50%; Increase the percent of patients with TIA and atrial fibrillation who receive oral anticoagulation (coumadin or dabigatran) within the emergency department, where no contraindications exist, to 90%; Increase the percent of patients with suspected acute stroke who are admitted to a stroke unit from the emergency department, to 50%; Increase the percent of patients (including family and/or care givers) with suspected acute stroke and TIA who receive stroke education in the emergency department, to 80%.

12. Collaboratives Provide … • Accelerated improvement • Cross-learning between sites • Capacity and capability for improvement • Creation of a culture of improvement and changing behavior • Access to high quality presentations • Access to faculty with expertise in both Stroke/TIA and Quality Improvement • Ideas and strategies for change • Supporting changes to reflect local context

13. Collaborative Elements (and Benefits!) • Face-to-face Learning Sessions or workshops • Improvement skills and methods • Clinical expertise and presentations • Shared learning across sites • Access to expert faculty • Coaching from improvement advisors • Strategies for measurement to drive improvement • Monthly webinars and an interactive website • Site visits if needed • Additional support to meet site’s CCM goals

14. Our Faculty • Dr. Philip Teal, Stroke Neurologist (VCH) • Dr. Valorie Cunningham, ED Physician (VIHA) • Sherry Stackhouse, Leader, Accreditation & Patient/Client Satisfaction Coastal HSDA (VCH) • Kevin Harrison, Regional Stroke Coordinator(FHA) • Jaymi Chernoff, National Stroke Nursing Council Representative & Trauma Coordinator (IHA) • Dr. Todd Collier, Stroke Neurologist (IHA) • Dr. Kennely Ho, Stroke Neurologist (FHA)

15. ED Stroke & TIA Collaborative Sites Register Virtual session Pre-work P P P P June 2 & 16 D A D A D A D A S S S S LS3 (virtual / Prince George) Celebrating Successes (Virtual) LS4 (Kelowna) LS1 (Vancouver) LS2 (Victoria) (Jan/Feb) 1 day April 16 & 17 Nov 14 & 15 Sept 19 & 20 June 19

16. ED Stroke & TIA Collaborative Sites Register Virtual session Pre-work P P P P D A D A D A D A S S S S LS3 Virtual/ Prince George Celebrating Successes Workshop (Virtual) LS4 Kelowna LS1 Vancouver LS2 Victoria Supports: Email Site visits website Webinars Assessments feedback reports

17. What is expected of your site? • Executive Sponsor support is critical to success • Participation in all bi-weekly calls and Learning Session • Planning, planning, planning • Doing, doing, doing • Data Collection on Collaborative measures • Submission of monthly progress reports • We are here to support you, so use us • Engaging staff, clinicians and administrators (selling your improvements)

18. What is expected of your site?

19. Next Steps • Enroll your site online http://www.bcpsqc.ca/events/strokecollaborative.html • $1000 / site registration fee will be invoiced to your site after registration • PHSA Stroke Services BC has allocated funding to each HA to support travel to Learning Sessions and Registration fees

20. Looking Ahead to Pre-Work • Start to assemble your teams • Physician champion? • Nurse champion? • Administrator? • Others… • Ensure that you have strong executive support for this improvement work • Talk to Noreen if you need help with this • Get potential team members to attend the pre-work webinars • Where are you with respect to Stroke & TIA? • Areas for improvement • Gaps in care

21. In Summary • This work is required as part of Clinical Care Management (MoHS KRA) • We believe a Collaborative offers the best opportunity for success • Participation in the Collaborative provides: • platform for sites to break out of their silos and learn from each other • build capacity for improving stroke in the ED such that the changes are sustained • Future phases of CCM for Stroke/TIA (best practice /guideline implementation): • Inpatient units (stroke units and general) • Inpatient rehabilitation • Community reintegration and support • This is our opportunity to accelerate the improvements for care in the emergency department for Stroke & TIA!

22. Discussion and Questions Contact Rebecca Brooke, Project Coordinator Phone: 604.668.8227 Email: rbrooke@bcpsqc.ca