Abstract WP350: Evolution of a Stroke Center Utilizing Systems Thinking and Collaborative Strategies

Background: As a large health system, positioned in the stroke belt, expansion was essential to meeting the growing demand for stroke care. The mission and vision was to meet the needs of stroke patients and become a recognized leader in stroke care in the South East. Stroke Center leadership established a strategic plan to gain organizational commitment to achieve this goal. Methods: In 2003, patients were cared for in a 6-bed stroke unit and a 30-bed acute care unit directed by Neurology. These beds became increasingly insufficient and care delivery fragmented. While still being able to meet patient needs and achieving Primary Stroke Center designation, the center lacked a comprehensive delivery model. Initial goals began with increasing capacity, volumes and streamlining care. Strong multidisciplinary partnership was crucial for change. To streamline care, Neurology and Neurosurgery partnered to create a NeuroCare Team (NCT) and aligned themselves under Surgery Services. The 8-bed Neurosurgery Intensive Care Unit expanded to a 16-bed Neuroscience Intensive Care Unit, the step-down converted to 18 stroke-capable beds, the 6-bed stroke unit dissolved and a 36-bed acute care unit designated stroke capable. All levels of care were now able to provide consistency by stroke trained nursing staff and physicians. With this increased capacity, the team implemented a new patient flow framework called ‘Open Access’. This concept required each member of the team to say ‘yes’ to stroke patient referrals, every patient, every time. The multidisciplinary team created a plan for bed availability to accommodate this vision. Results: Between 2009 and 2010, the center expanded capacity from 36 to 72 stroke-capable beds, with volumes increasing for outside hospital transfers by 100% in FY11. The Stroke Center was recognized by the American Heart Association’s Get With The Guidelines Bronze Achievement Award and by US News and World Report as a High Performing Hospital in 2012. Conclusions: Clinical collaboration, strategic leadership and organizational commitment can build a high quality, comprehensive and financially strong Stroke Center. Alignment of physician and nursing staff delivering stroke care is key to streamlining, consistency and quality of care.