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Neuroscience Institute

Quality of Care and Outcomes

AHA/ASA Get With the Guidelines® Stroke Performance Achievement Awards

Get with the Guidelines Gold Plus AwardAllegheny General Hospital was recently awarded the 2013 American Heart Association/American Stroke Association (AHA/ASA) Get With The Guidelines® Stroke Gold Plus Performance Achievement Award.

This award recognizes our commitment and success in implementing excellent care for in-hospital stroke patients, according to evidence-based guidelines from the American Heart Association/ American Stroke. The AGH Comprehensive Stroke Center was the first in the region to receive the Gold Award distinction in 2008 and has been recognized annually since then.

Joint Commission and AHA/ASA Get with the Guidelines Reported Performance Measures

  1. Patients with acute stroke who arrive at the hospital within 2 hours and receive IV rt-PA within 3 hours.
  2. Patients with stroke who are not able to walk independently will receive preventative therapies to prevent blood clots in the legs.
  3. Patients with stroke or TIA, and have Atrial Fibrillation or Atrial Flutter will be treated with anticoagulants (blood thinning medication).
  4. Stroke patients or caregivers who smoke will be given information and advice on smoking cessation.
  5. Stroke patients with abnormally elevated LDL (bad form of cholesterol) will be prescribed a statin (cholesterol reducing medication) or their cholesterol medication dosage will be adjusted.
  6. Early testing for swallowing disorders before patients are given food, fluids, or medication by mouth.
  7. Stroke patients or their caregivers are educated and/or given educational materials about stroke. risk factors, warning signs of stroke, activation of emergency medical system, need for follow-up after discharge and medications prescribed.
  8. Stroke Patients may be assessed for rehabilitation services by a member of the rehabilitation team.
     

 

Highmark Quality BLUE Initiative

 

The AGH Comprehensive Stroke Center actively participates in the Highmark Quality BLUE Initiative, a program that focuses on key healthcare quality issues that have been identified nationally as areas of opportunity for improvement. Since 2009, AGH has received the highest recognition for its participation in the Quality Blue stroke program by scoring 90% or greater in the AHA/ASA stroke “defect-free” care measure during the 9-month program period.

Stroke Center of Excellence

The AGH Comprehensive Stroke Center received NeuStrategy’s Stroke Center of Excellence (COE®) Designee award for 2008-2009. According to NeuStrategy, The COE Survey measures self-reported infrastructure to gauge a hospital or healthcare organization's aggregate capabilities to foster high-quality patient care environment.

Pennsylvania Health Care Cost Containment Council (PHC4)

The PHC4 is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of healthcare, and increasing access for all citizens regardless of ability to pay. The Council collects inpatient hospital discharge records each year from hospitals in Pennsylvania. PHC4 reports and data can be found on the Council's Web site, and in most public libraries throughout the state. Based on the most recently posted data (PHC4 2009 Spring Update), AGH hemorrhagic stroke patients have a significantly lower than expected mortality rating as compared to all other Allegheny County hospitals with expected mortality.

The AGH Stroke Center Performance Improvement Program

The Plan, Do, Study and Act Cycle (PDSA) is utilized as the performance improvement model at AGH. Program performance improvement and measurement is focused on areas in which the quality of patient care and safety may be improved and are identified in the medical literature, by certification and accrediting organizations, and by the program leadership.

Results are reviewed monthly by the Stroke Program Director, Stroke Unit CRNP and program leadership with variances reviewed in detail. Data is presented quarterly to the multidisciplinary Stroke Steering Committee for further review and analysis, and to the hospital based Compliance Coordination Committee which reports all findings to the hospital Board of Directors. The Stroke Leadership Committee meets bi-weekly to monitor and advance the stroke program. This includes:

  1. the evaluation of quality improvement initiatives,
  2. identification of barriers and proposal of solutions with respect to house-wide stroke inpatient and outpatient care,
  3. development and implementation of new technology and innovation, and
  4. steering the research program
     

Carotid Endarterectomy Outcomes

Allegheny General Hospital’s Division of Vascular Surgery is recognized for experience and safe outcomes with carotid endarterectomy (CEA) for the prevention of stroke. Carotid endarterectomy is a procedure in which a surgeon makes an incision in the neck overlying the carotid artery – the major blood vessel bringing blood to the brain - and removes fatty deposits that cause stenosis (narrowing) of the artery.

During the past 3 years (2009-2011), AGH vascular surgeons have performed CEAs in 525 patients. Patients who have a recently experienced a stroke due to carotid artery stenosis (symptomatic patients) and patients who have not experienced a stroke (asymptomatic patients) due to carotid artery stenosis may undergo CEA to prevent the likelihood of having a future stroke event. Our experience demonstrates excellent outcomes as compared to nationally recognized benchmarks: 

  Symptomatic Patients Asymptomatic Patients
AGH Patients (n) 92 435
AGH Stroke or Death Risk 2.2% 0.7%
National Benchmark <6%1 <3%2

References

  1. Furie KL, Kasner SE, Adams RJ et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack -A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research. Stroke. 2011;42:227-276.
  2. Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the atherosclerotic peripheral vascular disease interdisciplinary working group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2006;113: e873-923.

Learn more about carotid endarterectomy at AGH
 

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