News Release

Increasing nurse practitioners’ role in stroke care decreases complications, deaths and length of stay

Peer-Reviewed Publication

American Heart Association

NEW ORLEANS -- In many instances, researchers say, it's the complications from the stroke -- such as pneumonia or infections -- that poses the biggest threat to the recovery of patients.

Study results were presented here today at the American Stroke Association's 25th International Stroke Conference. The American Stroke Association is a division of the American Heart Association.

According to researchers, adding nurse practitioners to a hospital's acute stroke team can dramatically reduce complications, leading to decreased hospital stays, fewer deaths and better patient recovery.

"For years we had people who believed that stroke care was not a priority and there was nothing anyone could do for stroke patients," says the study's author, Patti Vanhook, R.N., of Indian Path Medical Center in Kingsport, Tenn. "A change had to be made. Our nurse practitioners have taken ownership for caring for patients upon arrival in the emergency room and all the way through their stay at the hospital."

Vanhook says that in December 1995, Indian Path Medical Center -- a 300-bed acute care community hospital -- changed its method of stroke care from standard physician care to a multidisciplinary team approach facilitated by a nurse practitioner. To determine the results of those changes, researchers examined medical records of 537 stroke patients who were admitted to the medical center from January 1996 through December 1998.

Vanhook says 50 percent of stroke patients develop a condition known as aspiration pneumonia that occurs when any fluid goes directly into the lungs. Stroke patients who may have problems swallowing can develop aspiration pneumonia, leading to longer hospital stays and added costs. Nurse practitioners bring in a speech pathologist upon admission to help patients with swallowing, reducing the incidence of aspiration pneumonia.

"Aspiration pneumonia is a good example of a post-stroke condition that can be prevented by getting the patient into therapy immediately," says Vanhook. "By making sure the patient is positioned in the bed correctly and they are being fed in a safe manner, this complication is a rare occurrence with our patients."

Another common complication that increases the death rate and cost is urinary tract infections, which are associated with bladder catheterization. Vanhook says that using the catheter only when needed instead of in routine practice decreases the number of complications.

Before the changes to combat aspiration pneumonia and urinary tract infection were made, the average length of stay for stroke patients was one week. Following the changes, the average length of stay was 3.7 days. Also from a financial standpoint, Vanhook says hospital charges were cut in half. In the study, Vanhook and her colleagues found that the death rate for stroke patients decreased from 5.7 percent before the changes to 3.8 percent after the changes. Urinary tract infections were less frequent, dropping from 4 percent to 2.5 percent and instances of pneumonia went from 4.6 percent to 1.9 percent. Deep vein thrombosis, a condition which results in blood clots forming in the extremities, was practically eliminated once changes were implemented.

"From the administrative standpoint, we made inroads in reducing length of stay and overall costs," says Vanhook. "More importantly, we helped lower the complication rate and subsequently decreased the number of deaths from stroke." Along with in-hospital changes, the stroke team at Indian Path mounted an aggressive community education program. Through those efforts, the average time from onset of symptoms to hospital arrival decreased 41 percent from 15.1 hours to 9.2 hours.

Nurse practitioners coordinate the stroke team and medically manage the patient in the emergency department after initial triage assessment by the emergency physician. The practitioner completes a medical history and physical exam of the patient, interprets laboratory studies, educates the patient and family about stroke, makes recommendations for discharge and assures the patient receives care from specialists.

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Co-authors are: John G. Stamoulis; Kay Bone; Michael S. Dew; Elizabeth A. Krell; Dan Robertson and Gregory C. Corradino.


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