Utilizing APRNs and PAs in Acute Stroke Response WENDY DUSENBURY DNP, APRN-BC, CNRN, ANVP-BC

Utilizing APRNs and PAs in Acute Stroke Response WENDY DUSENBURY DNP, APRN-BC, CNRN, ANVP-BC

Presenter Disclosure Information Wendy Dusenbury, DNP, APRN-BC, CNRN, ANVP-BC Utilizing APRNs and PAs in Acute Stroke Response FINANCIAL DISCLOSURE: No relevant financial relationships exist

Objectives 1. Discuss APRN/PA acute stroke response involvement in improving outcomes for stroke patients. 2. Identify system barriers to providing stroke care. 3. Summarize the medical and nursing management of the complex ischemic and hemorrhagic stroke and implement appropriate strategies in the clinical care of critically ill patients with acute stroke.

What We Face Increased Expectations Improvement of Outcomes Increase Productivity Decreased Resources Shortage of Trained Professionals We are expected to do more with less

The Solution to the Problem We All Need to be Superheroes

Our Story

Best Practices Recognized by The Joint Commission in 2014 survey as a leading practice for APRN/PA as Stroke Responders

Background Via Christ Hospitals, Inc. St. Francis Licensed for 857 Beds Primary Stroke Center certified by The Joint Commission since 2005 St. Joseph St. Teresa

Current Model Neuro-intensivist Neurocritical Care Unit (NCCU) in person or by phone within 5 minutes 24/7 Acute Stroke Call in person or by phone within 5 minutes 24/7 APRN/PA Physically present in NCCU 24/7 Responds to stroke calls 24/7

Stroke Physicians James Walker, MD Medical Director Neurocritical Care and Stroke Program Scott Johnson, MD John Peterson, DO Justin Sandall, DO

Acute Stroke Responders Sherry Bahr, APRN Zachary Castor, PA Wendy Dusenbury, APRN Amanda Holtzinger, PA Sierra Patton, PA LeighAnn Persondek, APRN Jennifer Smith, PA Rhonda Young, APRN

The Importance of a Team

Statistics Strokes (2014) 600 Ischemic Strokes 140 Intracranial Hemorrhages 65 Subarachnoid Hemorrhages

Statistics Stroke Team Activations Approximately 60+ per month Demographics (2014) 91% Caucasian Average Age 66 years

Treatment IV tpa Treatment Rate 15-20%(2014) 16% 1 st and 2 nd quarter 2015 Hemorrhagic Transformation Rate 4.2% (2014) 0% (2015) Endovascular Treatment Rate 17% (2014)

Stroke Admissions and Discharges Admissions 56% admitted to the neurocritical care unit Discharges 52% are completed in the NCCU 84% admitted to NCCU during 1 st Quarter 2015 were discharged from NCCU.

Responsibilities of the Acute Stroke Response Team (ASRT) Responder Respond to patient s location Obtain brief report Coordinate with nurse to ensure proper physician notification occurs (attending/resident) Collaborate with nursing Collaborate with stroke physician regarding exam and treatment decision Document the stroke activation and arrival times in EMR

ASRT Responsibilities Document the findings in progress note or history and physical Obtain consent for tpa Document the treatment decision including indications or contraindications Communicate information with appropriate physician and/or other health care providers Assist with initiation of the thrombolytic frequent monitoring flow sheet

ASRT Responsibilities Participate in initiation of treatment Support the primary nurse (does not assume direct care) The primary role is to assess neurologic dysfunction and intervention

Benefits of APRN/PA Responders Ability to conduct an advanced, specialized assessment Ability to direct patient care under established protocols Ability to make advanced decisions and order appropriate diagnostics/medication Potential financial benefits Streamline care between emergency department and NCCU

The Proof is in the Numbers APRN/PA Response Model In place since October 2011 Average DTN of previous models 83 minutes Average DTN October 2013 (APRN/PA Team) 52 minutes Current DTN 40-50 minute range 41 Minutes June 2015

Improving Outcomes Significantly reduced Door to Needle Time Discharging patients out of the ICU Decrease in hospital length of stay Impacting healthcare dollars spent on stoke

Team Accomplishments Recently received Target Stroke Honor Roll Elite Plus Award (Time to thrombolytic therapy within 60 minutes in 75 percent or more of acute ischemic stroke patients treated with IV tpa AND door-to-needle time within 45 minutes in 50 percent of acute ischemic stroke patients treated with IV tpa *June 2015 86% were within 45 minutes

Team Accomplishments 2 members of the team are board certified as Acute Neurovascular Practitioners, with 3 more members completing requirements to test in the near future 4 APRNs Certified Neuroscience Registered Nurses (CNRN) International conference presentation

Moving Forward Comprehensive Stroke Center Designated floor beds for stroke patients to cohort those patients to a common area with specialty trained nursing staff starting September 2015 Follow up stroke clinic with APRN/PA being first line provider working in conjunction and in collaboration with a neurologist in near future Grant funding to provide specialized education to nursing in stroke areas of hospital leading to national certification

Moving Forward CT Scanner in emergency department

Summary Medical and nursing management of the complex stroke and implementation of appropriate strategies in the clinical care of critically ill patients requires an entire team. Every system and team will likely look different The Key is to find a champion! Work the process until it works for you Practice! Practice! Practice! What ever your process is, make your patients the priority and everyone will win Thank You

Contact Information Wendy Dusenbury Stroke Program Manager Via Christi Health 316-268-7178 wendy.dusenbury@viachristi.org