Matching Items (2)
Filtering by

Clear all filters

162141-Thumbnail Image.png
Description
BACKGROUND: Stroke is a serious condition associated with significant morbidity and mortality. Of the 800,000 strokes that occur in the United States annually, one quarter can be described as recurrent events. Timeliness of care and patient education are considered critical tenets of stroke management. These interventions limit neuronal loss and

BACKGROUND: Stroke is a serious condition associated with significant morbidity and mortality. Of the 800,000 strokes that occur in the United States annually, one quarter can be described as recurrent events. Timeliness of care and patient education are considered critical tenets of stroke management. These interventions limit neuronal loss and prepare the patient to adopt lifestyle changes that prevent recurrent stroke. Several previous studies demonstrate that the use of patient navigator programs can improve clinical outcomes in this patient population. METHODS: A stroke navigator quality improvement program was designed and deployed at a stroke center in the American Southwest. During the 3-month study, patients diagnosed with stroke were enrolled by means of implied consent (n=52). Subjects were followed from emergency department presentation to discharge. Interventions aimed to reduce times from door to computed tomography (CT), door to alteplase, and door to thrombectomy. Patients were also provided education, emotional support, and case management. Positive response was defined as reduction in time taken to achieve core measures when compared with baseline institutional data. RESULTS: Two-tailed Wilcoxon signed rank tests were utilized to compare two large data sets: baseline door to CT, alteplase, and thrombectomy mean times for three months preceding the intervention to the three month period during which the intervention was deployed. No statistical significance was demonstrated. Next, the same test was used to compare baseline CT time data to the smaller group of patients that were treated by the stroke navigator. This showed that the stroke navigator yielded significant reduction in door to CT times when compared to baseline institutional performance (p=0.015). CONCLUSION: In concurrence with previous research, the stroke navigator program was successful in improving the quality of stroke care, notably during the acute phase when expedited computed tomography is needed to prevent neuronal loss. Further research is needed to determine if the intervention could improve door to alteplase and thrombectomy times as well as prevent stroke readmissions.
Created2021-04-23
126908-Thumbnail Image.png
Description

There is an estimated 6.2 million people Americans over the age of 20 suffering from Heart Failure (HF) (Bejamin et. al., 2019). It is essential that HF patients have sufficient knowledge about the disease and self-management (Abbasi, Ghezeljeh, & Farahani, 2018; Dinh, Bonner, Ramsbotham & Clark, 2018). Lack of self-management

There is an estimated 6.2 million people Americans over the age of 20 suffering from Heart Failure (HF) (Bejamin et. al., 2019). It is essential that HF patients have sufficient knowledge about the disease and self-management (Abbasi, Ghezeljeh, & Farahani, 2018; Dinh, Bonner, Ramsbotham & Clark, 2018). Lack of self-management is largely to blame for many HF exacerbations. Current evidence supports utilizing both verbal and written education with an emphasis on self-care and education delivered in a group setting or individual setting showed equal impact on self-care and HF knowledge ( Hoover, et. al., 2017; Ross et. al., 2015; Tawalbeh, 2018).

An outpatient VA clinic located in a suburb of the large metropolitan identified there was no consistency on how a HF patient was educated, managed, or tracked and the registered nurses (RNs) lacked knowledge of HF. As a results of these findings this Evidence Based Project (EBP) was implemented. RNs were educated on HF and completed a self-assessment questionnaire evaluating their knowledge pre and post education. The RNs, as part of a multidisciplinary team, educated HF patients on signs and symptoms of HF as well as on how to manage the disease. Patients completed, the Kansas City Cardiomyopathy Questionnaire (KCCQ) to assess quality of life and the Self Care Heart Failure Index (SCHFI) to assess knowledge of HF and self-management skills.

These questionnaires were completed initially and at 30 and 60 day intervals. The RNs self-assessment of their knowledge and ability to educate patients increased in all areas. The patient’s KCCQ and SCHFI score improved at 30 days and 60 days when compared to their initial score. Larger EBPs are needed over a longer period of time to assess the impact on hospital readmissions and same day clinic visits for HF exhibitions.

ContributorsSpano, Emily (Author) / Rauton, Monica (Thesis advisor)
Created2020-05-05