News Release

Small Changes In Care Lead To Big Benefits For Stroke Patients

Peer-Reviewed Publication

American Heart Association

DALLAS, June 5 -- By simply streamlining care of stroke patients, a hospital "stroke team" can save more lives, reduce hospital stays and create substantial cost savings, according to a study in an American Heart Association journal.

Clinicians at the North Mississippi Medical Center in Tupelo, Miss., fine-tuned their care of stroke between 1995 and 1997 and -- among other significant improvements -- lowered by nearly 50 percent the number of people who died from a stroke.

"Obviously people come to work and intend to do a good job every day, but if you don't look at what you're doing you may not realize that you can improve," says Jan Englert, R.N., of the clinical efficiency department, North Mississippi Medical Center. "We worked with the doctors to determine what could be automatically done to proactively improve the stroke patient care."

In 1995, 356 stroke patients were treated at an average cost of $7,111 per patient, an average stay of 9.9 days and a death rate of 11 percent (39 deaths). After undergoing a clinical practice analysis, which involved an extensive review of how stroke patients were treated, changes were made. Adding a stroke nurse case manager, for example, made it possible for one person to facilitate changes in stroke care and to export those changes to other hospitals in the health-care system.

In follow-up research in 1997, 399 stroke patients were treated, with the death rate dropping to 6.5 percent (26 deaths) and the average length of hospitalization reduced to just over a week (7.2 days). In addition, the average cost per patient dropped by just over 12 percent to $6,246.

One example of a small change that led to a large benefit was the number of people who developed aspiration pneumonia -- a condition that occurs when any fluid goes directly into the lungs. Stroke patients who may have still had problems swallowing can develop aspiration pneumonia, leading to longer hospital stays and added cost.

The number of people who developed the condition while in the hospital dropped by half (23 in 1995 to 11 in 1997) thanks to the changes.

"A sip of water seems pretty benign, but if it goes into the lungs and causes aspiration pneumonia, you've increased the cost of the hospitalization from about $5,000 to $26,000," says Englert. "This is just one example of why it's important to establish a protocol and have everyone follow it. Not only is it important for staff to follow the protocol, but for them to teach the guidelines to family members as well."

In their report in this month's Stroke: Journal of the American Heart Association, the authors say that improvements occurred in people treated by neurologists -- traditionally the physicians most involved in stroke treatment -- but also in those treated by internists.

A common perception is that stroke care is "inferior" in rural areas because health systems are perceived to be lacking the resources and capabilities of urban hospitals. While acknowledging that stroke is particularly draining financially in rural settings, the researchers say that changing stroke management and supporting those changes can dramatically help improve care.

"The main finding is that you can change practice patterns and make improvements overall," says Englert. "Using objective data and analysis provide an immediate impetus to make positive changes. Primary care physicians working with an informed team of caregivers can successfully manage the care of stroke patients."

The authors also found that patients are more interested in quality of life than just surviving the stroke.

"I've never heard anyone say, 'I just want to live no matter what happens,'" says Anita Box, R.N., a co-author and the stroke case manager for North Mississippi Medical Center. "Although we do live in a rural area with little communities where everybody helps take care of each other, they want to live with dignity and independence as long as possible."

Co-authors are Samuel D. Newell, Jr., M.D.; Kenneth M. Davis, M.D., M.P.H.; and Karen E. Koch, Pharm.D.

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