Institute for Healthcare Improvement: Expedition: Safe Care for Stroke Patients

OVERVIEW

This program is one way that IHI is helping hospitals implement a key component of the IHI Improvement Map.

The Climb

Stroke exacts a significant human toll. It is the single most common cause of disability and the third most common cause of death, accounting for nearly 1 out of every 17 deaths in the United States. Stroke also exacts a significant financial toll. The mean lifetime cost resulting from an ischemic stroke is estimated at $140,000 per patient, with an estimated overall financial burden in the US of nearly $53.6 billion. (Rosamond W, Flegal K, Friday G, et al. Heart Disease and Stroke Statistics—2007 Update.)

One of the most debilitating, dangerous, and costly consequences of stroke is dysphagia, or difficulty swallowing. This problem affects up to 65 percent of stroke patients, putting them at increased risk of aspiration from food, fluid, and medications entering the lungs. While swallowing problems are often difficult to detect, systematic screening of all stroke patients has been shown to improve outcomes by reducing pneumonia incidence, length of stay, and mortality.

Our ability to provide great stroke care has improved significantly, and there are now numerous interventions that, if reliably implemented, can lead to dramatically better patient care. These interventions are highlighted in the AHA/ASA’s Get With The Guidelines Stroke Program. Hospitals, however, are challenged to deliver each element of these guidelines reliably for every patient, every time.

The Goal

The aim of this Expedition is to enable participants to improve the outcomes of stroke patients by helping hospitals increase the reliable delivery of processes such as dysphagia screening. The program will help standardize processes and reduce variation, with a focus on the AHA/ASA’s Get With The Guidelines Stroke Program as a best practice to improve quality of stroke care.

Objectives

At the conclusion of this Expedition, participants will be able to:

Identify the key elements for providing optimal stroke care
Develop processes for ensuring that dysphagia screening is delivered reliably
Test, refine, and implement key strategies targeted at improving outcomes for stroke patients

Who Should Participate

Physicians
Nurses
Nurse Managers
Clinical Managers
Directors
Quality Managers

WHAT IS AN EXPEDITION?

WHAT'S INVOLVED?

ex•pe•di•tion (noun)

1. an excursion, journey, or voyage made for some specific purpose

2. the group of persons engaged in such an activity

3. promptness or speed in accomplishing something

An Expedition is a topic-specific, action-focused program, lasting three to five months, designed to help front-line teams make rapid improvements in a key components of the Improvement Map. Think of it as an intensive virtual support system, designed to enable widespread uptake of an important hospital improvement.

This Expedition is for hospitals that would like some help along the way from expert faculty serving as your guides and through the support of other organizations who are taking on the same challenge at the same time.

Successful Expedition

“The CA-UTI Expedition . . . was a wonderful experience. Participating in an IHI-sponsored national project helped our credibility and increased our ability to overcome challenges that might have been insurmountable a few months ago. We have made progress by taking part in the Expedition and we will continue to build on what we have learned thus far. We would definitely recommend that any hospital participate in an Expedition if they are interested in making changes . . . that lead to better patient outcomes.”

Pam Webb, RN, CIC
Infection Control Officer
Benefis Hospital
Great Falls, Montana

The Program

This program will include:

Send-Off Call to orient all teams, review the route, and provide guidance for specific steps
Check-In Calls every two weeks for faculty to provide advice and mid-course adjustments
Ongoing opportunities to share with and learn from other participating organizations
Opportunities for periodic check-ins with faculty
Concluding Call to reflect on the achievement and plot the next climb

Success Factors

Teams will need the following to be successful in this Expedition:

Strong team-based improvement capacity
Designated team, ideally to include a nurse working on the testing unit or able to lead the work, an internal quality/performance improvement expert, and a physician champion
Sponsorship and support from hospital leadership
Clear commitment to the goal and the process