J Clin Outcomes Manage
Impact of a stroke admission protocol - a quality improvement project
Rather MR, Mehta RS, Akbar A, Usman MH
Abstract Objective: To assess the impact of a standardized admission protocol for patients with ischemic stroke on stroke-related outcome variables. Methods: Retrospective chart review conducted on patients admitted with ischemic stroke between January 2003 and December 2007. Studentís t test and Pearson chi-square test were used for data analysis using SPSS 16. Results: Significantly more patients received aspirin at the time of admission (81% vs. 67%; P = 0.036) and received aspirin plus dipyridamole upon discharge (27% vs. 8%; p = 0.001) during the post-intervention period. The use of statins increased severalfold at admission (63% vs. 28%, P < 0.001) and almost doubled (64% vs. 33%) upon discharge in the postintervention phase. The use of ACE inhibitors at discharge also improved appreciably from 38% to 53% in the postintervention phase (P = 0.047). The use of diagnostic studies including MRI of the head, ultrasound of carotid arteries, and 2D echocardiogram showed statistically significant intensification. More frequent DVT prophylaxis in the postintervention phase (76% vs. 55%, P = 0.04) resulted in fewer cases of DVT. Intensive dysphagia screening resulted in a notable reduction of aspiration pneumonia (P = 0.023). Conclusion: The introduction of a standard admission protocol for ischemic stroke patients can enhance patient care and improve patient outcome by coordinating the management plan at various levels of multidisciplinary care.
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