Connected Care Team Saves Brain Cells, Time, and Stroke Patient LivesSes s ion # 90 , Augus t 11, 2021

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Medical Director of Neurointerventional and Comprehensive Stroke Services at Metro Health – University of Michigan Health Assistant Professor of Radiology University of Michigan

Augus to Elias , DDS, MD

DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.

Program Coordinator - Process Improvement & Integration at Metro Health – University of Michigan Health

Dillon Fas s et t , BS, MSA

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Welcome

Program Coordinator - Process Improvement & Integration at Metro Health – University of

Michigan Health

Dillon Fas s e t t , BS, MSAMedical Director of Neurointerventional and

Comprehensive Stroke Services atMetro Health – University of Michigan Health

Assistant Professor of Radiology University of Michigan

Augus to Elias , DDS, MD

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Conflict of Interest

Augusto Elias, DDS, MDMedical Director of Neurointerventional and Comprehensive Stroke Services at Metro Health –University of Michigan Health

Dillon Fassett, BS, MSAProgram Coordinator - Process Improvement & Integration at Metro Health – University of Michigan Health

Have no real or apparent conflicts of interest to report.

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Agenda

• About Metro Health – University of Michigan Health

• Designing an Improved Stroke Care Program

• Establishing Care Plans Before Stroke Patients Arrive

• Streamlining Physician Consults

• Measuring Process Improvements

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Learning Objectives• Discuss the importance of connecting and activating the right specialty physicians

quickly to care for stroke patients.• Evaluate how communication technology and effective care team collaboration can

improve patient care, safety, and outcomes.• Evaluate how a smartphone app can be used to share critical contextual patient

information with the right care team members before the patient even arrives at the hospital.

• Review how to measure clinical improvements related to stroke care, including door-to-needle time, door-to-groin time, and door-to-recanalization time.

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About Metro Health – University of Michigan Health

• 208-bed hospital in Wyoming, MI• >250,000 patients annually• Certified Comprehensive Stroke Center • HIMSS Stage 7 Accreditation• Verified Level II Trauma Center• Accredited Chest Pain Center

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OurBusinessPhilosophy

Mission Vision

Stroke Care in Michigan

According to CDC

Na t iona lly

Number of Deaths: 146,383Annually

Deaths per 100,000: 39.9Population

Cause of Death Rank: 6Leading Cause of Disability

Kent County

~6,400 Stroke Admissions(2015)

102 cases of tPa Administration(2015)

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Types of Stroke Seen at Our Facility

Ischemic80%

ICH15%

SAH5%

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Every minute in which a s t roke is unt rea ted, the average pa t ient los es 1.9 million bra in ce lls .

Each hour in which t rea tment fa ils to occur, the bra in los es as many neurons as it does in nearly four years of normal aging.1

1 Desai SM, Rocha M, Jovin TG, Jadhav AP. High Variability in Neuronal Loss: Time Is Brain, Requantified. Stroke. 2018;50:34–37

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Designing an Improved Stroke Care Program In October 2018, our neuroscience team set out on a project to further improve our stroke patient care program.

Goals: • Identify and reduce delays in stroke care delivery.• Analyze workflows and engineer workflow enhancements.• Ensure patients receive the fastest, highest quality care. • Implement a new clinical communication system.

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Sophisticated Use of IT to Help Patients

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Stroke Alert

Room 301 LTKW 10:45

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Automation Leads to Faster Patient Care and Better Outcomes

• Referring to call schedules leads to delays.

• Utilizing automation through our communication system makes it easy to connect with the right provider or care team.

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Establishing Care Plans Before Stroke Patients Arrive • Paramedics send a pre-arrival notification to stroke team members using the

smartphone app.• Notification includes contextual patient information such as:

• Name• Age• Medical record number• Time last known well

• Before the ambulance arrives, the right care team members have been activated and the right technologies and life-saving drugs are readily available.

The moment our patient hits the ED doors, we are ready to intervene.

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Sample ED Acute Stroke Patient Flow

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EMS

Pers

onne

l Pre-Hospital Arrival Notification Sent to ED Charge RN ED

Cha

rge

RN Pre-Hospital EMS Activation Notification Sent to Stroke Activation Team

Neu

rolo

gist Places IV

Thrombolytic (Alteplase) Order After Patient Evaluation and NCHCT

ED C

harg

e RN Administers

IV Thrombolytic

GOAL: IV Thrombolytic within 30 Minutes

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Metro Health Specific Pre-Hospital Alert Workflow

• Mapped out workflow identifying each step of the Pre-hospital Alert communication.

• The uniform process identifies: Who completes each action. What tools/instruments are used.

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Pre-Hospital Notification Received by Stroke Team

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• Includes vital information to begin processing the patient case even before they arrive, such as: Last Known Well Time Age ETA Room

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Metro Health Specific Stroke Neurologist Evaluation Workflow

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Stroke Neurologist Evaluation Notification Received by Stroke Team When Patient Arrives

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• Acts as a group message for decision making.

• Conversation can flow between the care team following the notification.

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Metro HealthCare Plan Communication Workflow

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df

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Care Plan Communication Notification Following Decision to Launch Neurointerventional Radiology Team

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df

• On-Call providers can select a response to let other know they received the notification and are on their way.

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• Outside hospitals transferring stroke patients to Metro Health for advanced intervention call M-LINE.

• Customized communication template sends case information to Metro Health’s neuro-interventional radiologists via the clinical communication app.

• Message include images, vital signs, and contextual information for patient pre-assessment.

Streamlining Physician Consults, Improving Outcomes

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47%

Decreased to a median of 30 Minutes

Improvement in Median Door-to-Needle Time

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Measurable Improvements:Median Door-to -Needle

• Decreased from a median of 42 minutes to 30 minutes.

• Median lifespan savings of 1 year, 190 days per patient.

Measured using the time of patient arrival to the ED to the time the patient received IV Thrombolytic.

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46%Improvement in Median

Door-to-Groin Time Decreased to a median of 80 Minutes

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Measurable Improvements:Median Door-to -Groin

• Decreased from a median time of 93 minutes to 80 minutes

• Median lifespan savings of 316 days per patient 46%Improvement in Median

Door-to-Groin Time

Measured using the time of patient arrival to the ED to the time of arterial access in the neurointerventionalsuite during thrombectomy.

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Decreased to a median of 120 Minutes

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Measurable Improvements:Median Door-to -Recanalization

• Decreased from a median time of 133 minutes to 120 minutes.

• Median lifespan savings of 316 days per patient 15%Improvement in Median

Door-to-Recanalization Time

Measured using the time of patient arrival to the ED to the time of recanalization during a thrombectomy.

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Key Takeaways

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• Earlier involvement of the care team allows faster identification of stroke patients.

• Faster identification leads to expedited intervention. • Uniform communication platforms allow for a

streamline care process leading to improved patient outcomes.

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Questions?

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Thank you!

Augusto EliasAugusto.Elias@metrogr.org

Dillon FassettDillon.Fassett@metrogr.org

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