Someone in the U.S. has a stroke every 40 seconds, and a life is claimed every four minutes – a death that is often preventable.
All told, about 133,000 Americans die from strokes each year. Those who survive are often at risk for serious lifelong disabilities such as loss of mobility or speech.
Identifying optimal ways to care for patients at risk, or who have had a stroke, has proven to be challenging. Hospitals, in particular, face obstacles managing stroke patients. Issues to be addressed include accessibility to healthcare providers; prompt treatment; adherence to provider recommendations after initial therapy to prevent future strokes; education about the role of diet and exercise; and of course, encouraging healthier lifestyles and behavior.
Charleston Area Medical Center (CAMC) is the flagship facility for CAMC Health System, a three-hospital healthcare network with a total of 838 beds that is based in Charleston, West Virginia, that state’s capital and largest city. Finding ways to improve stroke care access and outcomes was of great interest in the state, as West Virginians are particularly vulnerable to strokes. According to the American Stroke Association, nearly 69% of the state’s residents are over-weight or obese, significantly higher than the national average. Partly as a result, nearly 4% of West Virginians have had a stroke, a rate more than a third higher than the national average.
For those suffering from ischemic strokes -- a blockage of a vessel supplying blood to the brain -- patients may be given a clot-dissolving medicine called tissue plasminogen activator, or t-PA, However, if it is not received within three hours of the onset of a stroke, it will have little to no effect.
Recognizing the need for identifying better ways to treat stroke patients, over the past several years the hospital has undertaken a number of initiatives. The goal was to find new ways to ensure that patients got the right treatment at the right time.
Our organization, DNV GL-Healthcare, is the second-largest hospital accrediting body in the United States. We were brought on to support CAMC efforts. DNV GL currently accredits 500 hospitals in 49 states. We are the first organization in the US to adopt the ISO 9001 model for hospitals.
ISO 9001 is a quality control system that was originally used in the manufacturing sector. Because of its emphasis on quality, outcomes, consistency, and education, we saw considerable applicability for healthcare settings. While well-known in manufacturing and other industries, especially in Europe where it was pioneered, the use of ISO in healthcare in the U.S. is in its infancy.
The program for CAMC began with two separate surveys on its delivery of services to stroke patients, Recommendations included:
- Closing gaps between onset of a stroke and an encounter with a neurologist
- Ensuring patients receive t-PA within one hour of their stroke
- Providing prompt antithrombotics and anticoagulation therapy
- Giving patients at risk for a stroke counseling on diet, smoking cessation and medications, specifically cholesterol-reducing drugs
- Development of a telestroke program to help ensure patients get care from a neurologist, even if they are not on the hospital premises
Following implementation of recommendations, CAMC strengthened its program for stroke victims, including creating more timely interventions by its team of eight neurologists. As a result of a comprehensive approach to stroke management, the number of ischemic stroke patients who received t-PA within an hour of their stroke increased to 140 between April 2016 and April 2017. That’s compared to approximately 30 between the similar 2015-2016 period. The hospital has also significantly improved the amount of time from diagnosis to when patients receive antithrombotics and anticoagulation therapy. Additionally, after discharge, patients are prescribed cholesterol-reducing drugs and smoking cessation counseling if they need either or both. Equally important, the hospital has created a telestroke program, assuring more prompt care from a neurologist and making access to providers easier for CAMC patients in rural areas, or who lack transportation.
Because of the changes that were facilitated through the ISO9001 program, CAMC has received three consecutive Get with the Guidelines – Stroke Quality Achievement Award from the American Stroke Association for providing excellent stroke care. Hospitals receiving the Get with the Guidelines – Gold Plus Achievement Award have reached an aggressive goal of treating stroke patients with 85% or higher compliance to core standard levels of care as outlined by the American Heart Association/American Stroke Association for 12 consecutive months. Also, those hospitals have demonstrated 75% compliance to seven out of 10 stroke quality measures during the 12-month period. It’s an important accomplishment and achievement for a hospital in the thick of the battle against strokes in their community.
ISO 9001 is an important new strategy for hospitals looking for ways to improve quality and outcomes to consider. Unlike other accreditation bodies that tend to use more of a stick approach to quality improvement, ISO 9001 emphasizes, education, collaboration and support, and most importantly, sustainable results. The results at hospitals like CAMC highlight that it is a quality improvement initiative worth further exploration.
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About the Author: Patrick Horine is the chief executive officer and co-founder of DNV GL Healthcare USA, Inc., an accrediting body for more than 500 hospitals in 49 states. DNV GL's 6th Annual Healthcare Symposium for healthcare executives will be held October 9-12, 2017 in San Antonio, TX. For more information visit https://www.dnvgl.us/assurance/healthcare/Symposium2017/index.html
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.