Time is brain. That’s why every second counts when a patient experiences an ischemic stroke, which accounts for 87% of all stroke cases, according to the American Stroke Association.
Greater Baltimore Medical Center (GBMC) recognized that their tissue plasminogen activator (tPA) treatment rates were lower than national and state benchmark rates. Treating stroke patients with tPa, a blood clot-busting medication, within three to four hours of the incident can greatly improve prospects for recovery, including the duration of recovery time. Recognizing the importance of this, the medical center set a goal to leverage their EHR to improve recognition of qualified patients for tPA treatment and to administer tPA more efficiently and safely through workflow improvements.
The medical center focused on two main goals in improving tPa treatment for stroke:
GBMC knew that they could meet these goals and align more closely with state and national benchmarks by leveraging existing information system functionalities and adjusting processes that accompanies them. One of these functionalities included utilizing synonyms in the chief complaint field of the EHR to identify more strokes in the emergency department. They also developed a nurse-driven triage protocol and provider order set to standardize care, improve safety and make ordering more efficient.
To drive the new protocol and ensure the effectiveness of the new functionalities in the EHR, GBMC set a clear governance strategy to design and implement these workflow changes. Their work was focused on bringing together stakeholders and process improvements so that stroke identification could be recognized more in both inpatient and emergency department settings, and the new triage protocols would standardize care to improve the efficiency of the ordering process.
With these new workflows, GBMC was able to recognize more patients who might be experiencing a stroke and expedite tPA treatments to qualified patients, surpassing their goal of over 11% to exceed national and state benchmarks, while also remaining in line with the American Heart Association’s Get With The Guidelines standards.
After implementation of the new design for stroke treatment, thanks to faster identification, more than half of GBMC’s ischemic stroke patients were discharged to home or acute rehab.
A stroke patient who received care at GBMC provided this feedback to the stroke program coordinator: “Everything was excellent. Greater Baltimore Medical Center is the best place for stroke.”
The HIMSS Davies Award of Excellence recognizes the thoughtful application of health information and technology to substantially improve clinical care delivery, patient outcomes and population health around the world. The Davies Awards program promotes HIMSS’s vision and mission by recognizing and sharing use cases, model practices and lessons learned on how to improve health and wellness through the power of information and technology.
“Leveraging decision support to get stroke patients to the appropriate care interventions as quickly as possible saves lives and improves quality of life,” said Jonathan French, CPHIMS, SHIMSS, senior director of quality and value-based care at HIMSS.
“Greater Baltimore Medical Center not only optimizes their workflow with technology to deliver the right care at the right time; they also constantly measure performance against state benchmarking data to identify additional opportunities for improvement. HIMSS is proud to recognize Greater Baltimore Medical Center as the first HIMSS Enterprise Davies Award recipient from Maryland.”
“Greater Baltimore Medical Center is honored to receive the 2019 HIMSS Davies Award and takes great pride in its use of health information and technology to improve patient outcomes,” said David Hynson, chief information officer at Greater Baltimore Medical Center.
See the full list of 2019 Davies Award winners.
Updated March 6, 2020