Angela N. McCall-Brown, MSN, APN-C Stroke Nurse Practitioner Overlook Medical Center Neuroscience Center
Disclosures Nothing to Disclose
Co-Authors Dianna Barrett American Stroke Association Lyn Bertsch, BS Atlantic Health Systems Deborah A. Jewell, MS - Albany Medical Center Angela N. McCall-Brown, MSN, APN-C-Overlook Medical Center Shannon Melluzzo, BA - American Stroke Association Stephanie Rizzo BSN, RN, CNRN Thomas Jefferson University Hospital Emily Schaab, DNP - Mount Sinai Medical Center Joanne Turnier, MS, RN, ACNS, BC, CNRN, CT North Shore-LIJ Health System
Delineating the Stroke Coordinator Role: Recommendations of The Northeast Cerebrovascular Consortium
Introduction and Significance The stroke coordinator role has become essential to stroke center operations and quality stroke patient care Because job descriptions vary significantly across institutions, formal delineation of stroke coordinator responsibilities is urgently needed
Literature Review Recommendations for the establishment of primary (Alberts 2011) and comprehensive (Alberts 2005) stroke centers mention the designation of an APN as coordinator (Alberts 2005) However, most literature on the stroke coordinator role originates in the UK (Burton 1999, McDonald 2002, Perry 2004) The relevant US literature includes only: An international survey of stroke coordinators presented as a poster at the 2009 ISC Nursing Symposium (Alexandrov 2009) A 2009 AANN Synapse E-News article describing the role (Shappell 2009)
Research Design April 7, 2011 Survey Launched 5 page electronic web based survey All acute hospitals Promoted by: The NECC Stroke Coordinator Networks Departments of Health
What state are you from? 1. Maine 23% 2. New Hampshire 3. Vermont 4. Massachusetts 14% 16% 15% 14% 5. Connecticut 10% 6. Rhode Island 7% 7. New Jersey 8. New York 0% 1 2 3 4 5 6 7 8
Survey Results Hospital State New York 34 New Jersey 29 Massachusetts 18 Connecticut 13 Rhode Island 6 Maine 5 No Response 4 New Hampshire 4 Vermont 1 n = 114 0 5 10 15 20 25 30 35 40 Respondents
Did you complete this Survey? 1. Yes 2. No 3. Don t Remember 45% 40% 15% 1 2 3
120 100 80 97 Survey Results State Department of Health Designated vs. Joint Commission Primary Stroke Center n = 114 Respondents 60 40 42 40 20 0 State DOH Designated Joint Commision PSC Both Designations
Hospital Demographics 39 (24%) practiced in urban 55 (47%) suburban 16 (14%) rural areas 5 (14%) did not respond.
Survey Results Hospital Type Community hospital with primary stroke center capabilities 65 University-affiliated tertiary care hospital with primary stroke center capabilities University-affiliated tertiary care hospital with comprehensive stroke center capabilities 17 19 Community hospital with comprehensive stroke center capabilities 7 No response 5 Community hospital without stroke center capabilities 1 n = 114 0 10 20 30 40 50 60 70 Respondents
60 Survey Results Hospital Size n = 114 50 48 40 30 34 20 10 10 13-4 1 4 1-100 101-250 251-500 501-750 751-1,000 1,001-1,250 No Response Number of Beds
Respondent Demographics 114 stroke coordinators/data coordinators 6 (5%) males and 102 (89%) females 49 (43%) of the respondents were 45 or over 41 (36%) are supervised by the Department of Nursing 28 (25%) are supervised by Quality Assurance Department 20 (18%) Department of Neurology
Survey Results Educational Background Primary Stroke Center Comprehensive Stroke Center 8 9 2 4 39 28 75% of respondents 46% of respondents 18 Diploma or Assoc Baccalaureate Masters Other Diploma or Assoc Baccalaureate Masters Other 51%, or 58 of all 114 respondents, have a masters degree
Which response represents the type of hospital and number of hours dedicated to your stroke coordinator responsibilities? 1. Work at a Primary Stroke Center (PSC) and devoted more than 40 hours per week to stroke coordinator responsibilities (SCR) 2. Work at a Comprehensive Stroke Center (CSC) and devoted more than 40 hours per week to SCR 3. I devote less than 40 hours per week to SCR 4. I do not work at a PSC or a CSC 39% 16% 36% 9% 1 2 3 4
Survey Results Respondents Devoting > 40 hours per week to Stroke Coordinator Role Primary Stroke Center Comprehensive Stroke Center 20 24% of respondents 12 12 64 50% of respondents More than 40 hours per week Less than 40 hours per week More than 40 hours per week Less than 40 hours per week 29%, or 33 of all 114 respondents, devote > 40 hours per week to Stroke Coordinator role
Job Description Management Policy and procedure development Responsible for regulatory and stroke certification/designation requirements Policy and procedure development Responsible for regulatory and stroke certification/designation requirements Hospital with Primary Stroke Center Hospital with Comprehensive Stroke Center Formal reports to hospital wide committees and boards 89% 100% 93% 96% 93% 83% Formal reports to hospital wide committees and boards Supervision of professional staff Supervision of non-professional staff 31% 21% 37% 50% Budget 17% 30% 0% 20% 40% 60% 80% 100% Percent of Respondents
Job Description Hospital with Primary Stroke Center Hospital with Comprehensive Stroke Center Quality Implementation of quality methodology to improve performance Initiate quality improvement projects Implementation of quality methodology to improve performance Initiate quality improvement projects Facilitate (Lead) stroke quality improvement teams/meetings Develop presentations (summaries, graphs etc) for reporting quality data 83% 92% 83% 88% 83% 88% 85% 79% Facilitate (Lead) stroke quality improvement teams/meetings Develop presentations (summaries, graphs etc) for reporting quality data Data analysis and reporting Concurrent chart review Participate as member (non-facilitator) of stroke quality improvement team 67% 67% 88% 79% 82% 79% Data analysis and reporting Data Collection including chart abstraction 71% 63% Concurrent chart review Data entry 38% 63% 0% 20% 40% 60% 80% 100% Percent of Respondents
Job Description Hospital with Primary Stroke Center Hospital with Comprehensive Stroke Center Clinical Perform the NIHSS in your clinical practice Participation in the inpatient rounds for stroke Inpatient management working thru medical staff to assure appropriate diagnostic tests and medications (not responsible for direct patient management) Emergency Stroke team response as a member of the stroke team (not responsible for decision making) Perform the NIHSS in your clinical practice Participation in the in-patient rounds for stroke Inpatient management working thru medical staff to assure appropriate diagnostic tests and medications (not responsible for direct patient management) Emergency Stroke team response as a member of the stroke team (not responsible for decision making) Outpatient stroke service (clinic) as provider Inpatient clinical management ordering appropriate diagnostic tests and medications (responsible for direct patient management) Emergency Stroke team response as leader of the stroke team (responsible for decision making including administering IV t-pa) 6% 10% 19% 17% 25% 33% 48% 51% 48% 61% 71% 71% 71% 96% 0% 20% 40% 60% 80% 100% Percent of Respondents
Job Description Hospital with Primary Stroke Center Hospital with Comprehensive Stroke Center Staff Education Acts as stroke expert and resource to professional staff personally providing stroke education to physicians, nursing, allied health personal/ems Identified as responsible person for the development and implementation of a staff stroke education plan for hospital Acts as stroke expert and resource to professional staff personally providing stroke education to physicians, nursing, allied health personal/ems Identified as responsible person for the development and implementation of a staff stroke education plan for hospital NIHSS Trainer that trains other hospital staff Do not personally provide staff stroke education but coordinate stroke educational offerings 20% 25% 19% 17% 69% 74% 83% 96% 0% 20% 40% 60% 80% 100% Percent of Respondents
Patient Education Develops and/or selects stroke education materials utilized for patient education Job Description Hospital with Primary Stroke Center Develops and/or selects stroke education materials utilized for patient education Ensures that patient educational materials are reviewed for health literacy and cultural competence Hospital with Comprehensive Stroke Center 80% 100% 65% 63% Ensures that patient educational materials are reviewed for health literacy and cultural competence Not individually responsible for providing stroke education/counseling but reinforces education given by others Not individually responsible for providing stroke education/counseling but reinforces education given by others Individually responsible to providing stroke education/counseling to patient as the primary provider of that education Facilitates stroke support group 12% 25% 38% 38% 46% 58% 0% 20% 40% 60% 80% 100% Percent of Respondents
Community Education Personally provide community stroke education through lectures, interviews and presentations to audiences Use GWTG data to show where the patients come from and what risk factors they have already when presenting Job Description Hospital with Primary Stroke Center Personally provide community stroke education through lectures, interviews and presentations to audiences Do not provide lectures, interviews or presentations but distribute stroke education materials and answer individual questions by participating in health fairs and other public events Do not directly provide community education but arrange for speakers or participants at events Hospital with Comprehensive Stroke Center 69% 88% 20% 17% 17% 4% 0% 20% 40% 60% 80% 100% Percent of Respondents
Coming Soon Manuscript Publication (hopefully) Stroke Coordinator Job Description CHANGE!
Stroke Coordinators' Spheres of Influence Leadership Leadership Management Quality Education Management Stroke Coordinator Quality Reference: Sorensen,-Marshall E., (2011)Transformational leadership in nursing. New York, Springer Publishing Company Education
Sphere of Influence Health Care Organization Patient/Family Outcomes Health care team
Questions? For, as life s path we travel.with its every twist and turn.each trial is a lesson, from which the soul may learn.