Melanie Altamirano, DNP, ACAG-NP

Abstract:

Background: Code Stroke Teams in hospitals provide emergency deployment of stroke clinical care experts for treatment of an acute stroke. Code Stroke Teams monitor their effectiveness using standards for stroke patient outcomes provided by the American Heart Association (AHA) and American Stroke Association (ASA) Stroke measures. This project was conducted in a Southern California suburban hospital where changes in leadership and high turnover rates had led to Code Stroke Team members experiencing decreased motivation, job satisfaction and low morale leading to substandard stroke patient outcomes.

Aim: This quality improvement project aimed to empower staff, improve performance and stroke outcomes by giving monthly presentations of successful Code Stroke cases to the Stroke Performance Improvement Committee leaders and stroke team staff.

Methods: Stroke Performance Improvement Committee leaders and stroke team staff participated monthly in an empowerment intervention through presentation of a stroke case on a “Code Stroke Spotlight” handout (Educational Empowerment Tool) over a 3 month period. Using a repeated measures, pre- post design, staff empowerment (measured by the Psychological Empowerment Instrument) and American Heart Association (AHA) Core Emergency Department Stroke Measures were collected prior to the intervention at baseline and post empowerment intervention following monthly implementation over 3 months.

Results: Results showed statistically significant improvement in all items on the Psychological Empowerment (PE) Instrument using Wilcoxon signed-rank test (p<0.05) (N = 32). Door to neuro MD (neurologic expertise consult) <15 minutes showed significant improvement post intervention (z =-2.285, p = 0.023). Door to PT/INR result <45 minutes showed statistical significance (z =-2.931, p = 0.003). Door to CT film <20 minutes showed no change (z=0.000, p = 1.000). For the remaining goals there was improvement in right direction, demonstrating decreased door to activation times, though these did not reach statistical significance.

Discussion: Implementation of the ‘Code Stroke Empowerment Spotlight’ intervention effectively improved staff empowerment and performance on American Heart Association (AHA) and American Stroke Association (ASA) Stroke core measures. Future studies are needed to evaluate positive reinforcement, meaningful recognition, and empowerment specific to those caring for stroke patients.

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