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The Accreditation Canada Stroke Distinction Program: A Quality Improvement Strategy

The Accreditation Canada Stroke Distinction Program: A Quality Improvement Strategy. Wendy Nicklin, President and CEO April 9, 2014. Disclosure Statement. I have no conflict of interest or any financial gain associated with any material I am presenting today. - Wendy Nicklin. Outline.

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The Accreditation Canada Stroke Distinction Program: A Quality Improvement Strategy

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  1. The Accreditation Canada Stroke Distinction Program: A Quality Improvement Strategy Wendy Nicklin, President and CEO April 9, 2014

  2. Disclosure Statement I have no conflict of interest or any financial gain associated with any material I am presenting today. - Wendy Nicklin

  3. Outline • Stroke Statistics in Canada • Accreditation Canada and the Stroke Distinction Program • National and International • Program components and enhancements • Impact of participating in the Stroke Distinction Program through identified performance measures

  4. Accreditation Canada • Major national accreditation body for organizations across all health sectors in Canada, incorporated in 1958 • An independent, non-governmental, non-profit organization funded by its members • Over 1200 client organizations (6,000 sites) • International presence, including in Bermuda, Brazil, Italy, Saudi Arabia, Kuwait, and Ecuador • Accredited by ISQua • 2014

  5. Stroke Statistics in Canada • Third leading cause of death • 6% of all deaths are due to stroke (Statistics Canada, 2012) • Every year, patients spend more than 639,000 days in acute care hospitals and 4.5 million days in residential care facilities (Canadian Stroke Network, 2011) • 23% of patients are treated on a stroke unit • In hospitals with a stroke unit, 47% are not treated within the unit (Canadian Stroke Network, 2011)

  6. Stroke Statistics in Canada • Mortality rate is 43 per 100,000 people • Lower than most OECD members • Lowest among comparable countries • In-hospital mortality rate is 9.7 per 100 patients • Higher than the OECD average: 8.5 per 100 patients

  7. Rationale for the Stroke Distinction Program • More accountability is being placed on stroke care services • Stroke care services are high cost and high impact • Statistics Canada reports that stroke is one of the leading causes of death and adult disability • The Public Health Agency of Canada notes that stroke is one of the most impactful chronic diseases in Canada • Improving care and outcomes will result in efficiencies • Developed to recognize excellence in stroke care

  8. Stroke Distinction Program http://www.strokebestpractices.ca Accreditation Canada developed the program in collaboration with the Canadian Stroke Network Focuses on Canadian Best Practice Recommendations for Stroke Care Recognizes clinical excellence, leadership, quality, safety, & innovation On-site survey every 2 years Stroke distinction is an optional program

  9. Distinction Cycle

  10. Stroke Distinction Across Canada • 12 organizations currently participating in the Stroke Distinction program • 9 have achieved stroke distinction • 7 Canadian • 2 International • 3 have begun the process

  11. International Stroke Distinction™ • Introduced in Spring 2012 • Implemented in Latin America (Brazil) and Europe (Italy) • Highly recommended for organizations focused on innovation and research in stroke care

  12. Components of Stroke Distinction • The standards: • Acute Care • Rehabilitation • Integrated Systems • Other program components: • Performance indicators • Protocols • Innovation • Client Education

  13. Performance Indicators • Data is submitted regularly every 6 months between on-site visits • Organizations are required to: • Collect and submit data on all core indicators; • Collect and submit data on at least 2/11 optional indicators • Achieve the minimum data thresholds for: • Meet thresholds for 7/9 core acute indicators • Meet thresholds for 3/4 core rehabilitation indicators • Provide an action plan for unmet core thresholds

  14. Core Performance Indicators

  15. Protocols Acute • Emergency Medical Services (EMS) stroke screening • EMS bypass / direct transport to stroke centres (including air ambulance) • EMS pre-notification of stroke • Emergency Department notification of hospital-based stroke team • Neurovascular imaging for potential stroke patients (rapid access to CT) • tPA eligibility screening (based on current Canadian Stroke Strategy Canadian Best Practice Recommendations for Stroke Care criteria) • tPA administration • Administering acute ASA therapy • NEW FOR 2015 SURVEYS: Formal criteria for identifying appropriate clients for referral to inpatient rehabilitation

  16. Protocols Rehab • NEW FOR 2015 SURVEYS: Formal intake criteria for triaging client referrals and accepting clients for inpatient rehabilitation Acute & Rehabilitation • Swallowing ability assessment • Initial assessment of rehabilitation needs • Assessing and managing diabetes mellitus • NEW FOR 2015 SURVEYS: Pressure ulcer prevention • NEW FOR 2015 SURVEYS: Falls prevention • Requirements: Adopt and Implement • At least 6/11 acute care protocols • At least 2/3 rehabilitation protocols

  17. Innovation and Excellence Organizations must have at least one Q.I. project that meets all of the following criteria: • Is evidence based, e.g. aligned with accreditation standards and current Canadian Best Practice Recommendations for Stroke • Adds to the overall quality of stroke services within the facility or the region • Includes a completed evaluation, and measures sustainability of the project or initiative • Communicates findings within the organization and externally • Is notable for what it could contribute to the delivery of stroke services

  18. Patient and Family Education • Information provided at each phase of acute care, rehabilitation, community reintegration and long-term recovery should be relevant to the patient’s and the family’s changing needs • Organizations’ patient and family education must meet requirements set by Accreditation Canada • Availability of education material on the unit • Record of patient education

  19. Impact of participating in the Stroke Distinction Program through identified performance measures

  20. Results from Hospital A, CanadaStroke Distinction Scorecard

  21. Results from Hospital B, Canada 2010-2012 - Focused Process Improvements Led to: 20% Stroke Unit Utilization 5% In-hospital Mortality Rate 6.7% 90-day Readmission Rate 15% Dysphagia Screening Focused Review of Complication Rates: Quality Improvement Planning

  22. Performance Outcomes: Stroke Distinction and provincial average * Source: Institute for Clinical Evaluative Sciences, Ontario Stroke Evaluation Report 2012

  23. International Stroke Distinction™ • High satisfaction from the client organizations that have implemented the program with particular focus on improvement in integration of care and transparency in treatment process

  24. Results from Hospital C, Brazil • Patient and family education strengthened due to stroke program • Documentation including checklists developed for each member of multidisciplinary team • Organization developing telemedicine-based stroke protocol for application at other sites within its network

  25. Why organizations choose Stroke Distinction? • To build and accelerate excellence and innovation throughout the program and across programs • Improved awareness of best practices • To support the development and sustainability of a culture of improvement • To promote interest in and drives the use of performance data on an ongoing basis

  26. Why organizations choose Stroke Distinction? • To demonstrate ongoing commitment to excellence: • Supports improvement of patient outcomes • Confirms best practice care for patients and families • Strengthens team performance: recruitment and retention of staff; supports interprofessionalteamwork; improves communication and morale • Promotes research funding

  27. Ongoing updates: 2014 Revision of standards • Coordinated administration of tPA to ensure it is initiated within one hour of hospital arrival and monitor their administration times • Providing clients with written discharge information including action plans, follow-up care, appointments, and recovery goals • Screening and follow up of clients with changes in cognition • Screening and follow up of clients with depression • Determining smoking status and provide information on smoking cessation Self-assessment Other Distinction products • Trauma Distinction coming in Fall 2014

  28. Questions and Discussion Thank you for your interest!

  29. Wendy NicklinPresident and Chief Executive Officer613-738-3800 / 800-814-7769 ext. 268Wendy.Nicklin@accreditation.ca www.accreditation.caACCREDITATION CANADA: Driving Quality Health Services

  30. Proud to be aTop 25 employerfor five consecutive years Fier de faire partie des25 meilleurs employeurs depuis 5 années consécutives

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