Multidisciplinary protocol for rapid head computed tomography turnaround time in acute stroke patients.

BACKGROUND: The door-to-computed tomography (CT) head reporting time is an essential step to determining eligibility for thrombolysis in acute stroke patients, but the specific components of the process have not been reported in detail. METHODS: We performed a retrospective cross-sectional analysis of the prospectively collected Get-With-The-Guidelines database in our comprehensive stroke center to evaluate the effect of a structured multidisciplinary protocol on head CT times in acute stroke patients under consideration for thrombolysis. RESULTS: The median CT turnaround time in the first 6-month period was 27 (interquartile range [IQR], 27) and decreased in all subsequent periods after implementation of a formal protocol to 18 (IQR, 12; range, 17-20 minutes; P < .0001 for all pairwise comparisons). The median CT turnaround time was 18 (IQR, 12) versus 20 (IQR, 14) minutes for patients with admission diagnosis of stroke (n = 1123) versus nonstroke (n = 685; P < .0001), respectively. CONCLUSIONS: A structured multidisciplinary protocol for obtaining acute stroke protocol head CT scan was associated with reduced CT turnaround time over the study period. Prospective studies should be done to determine if implementation in other stroke centers confirms the effectiveness of our protocol.

A nursing quality program driven by evidence-based practice.

St. Luke's Episcopal Hospital in Houston established a best-practice council as a strategy to link nursing quality to evidence-based practice. Replacing a system based on reporting quality control and compliance, this Best Practice Council formed interdisciplinary teams, charged them each with a quality issue, and directed them to change practice as needed under the guidance of the St. Luke's Episcopal Hospital Evidence Based Practice Model. This article reviews the activities of the Best Practice Council and the projects of teams assigned to study best practice in (1) preventing bloodstream infection (related to central lines), (2) preventing patient falls, (3) assessing and preventing pressure ulcers, and (4) ensuring good hand-off communication.

Quality improvement: stroke plan-do-study-act for primary stroke center certification.

The 10-year aftermath of Shortell and colleagues' landmark intensive care unit study has resulted in healthcare institutions increasingly strategizing themselves into disease-specific niches. Specialization has evolved to the point at which The Joint Commission will certify exceptional disease programs. One such certification has been developed for stroke. The processes essential to attain stroke certification are detailed, complex, and outlined in this article.

Nurses' perceptions of open visiting hours in neuroscience intensive care unit.

A quality improvement project was undertaken by Neuro-ICU nurses to determine possible effects from open visitation. From a quality improvement perspective, nurses' concerns were investigated along with their perceptions about open visitation to determine a need for visitation policy revision. Vast variability in nurses' interpretation and implementation of individualized open visitation policy suggested a need for the following: staff education about the policy and its implementation, a review of the literature to determine the validity of concerns about deleterious physiologic effects on neuroscience patients from visitation, and improved communication among nurses about visitation.