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At Atrium Health, we built one of the first regionalized stroke networks, using a “hub-and-spoke” approach to diagnose, triage and treat stroke patients across more than 40 hospitals. And we’re continually looking to elevate stroke care even higher. That’s why we created the Code Stroke Registry – a patient information repository that helps harness “big data” to pinpoint inefficiencies, optimize protocols and make outcomes better.

From faster door-to-needle times to expedited transfers, here’s how our state-of-the-art data infrastructure and analysis helps identify roadblocks and improve care.

10,000 Patients – And Growing

We launched the Code Stroke Registry in 2016 to help us monitor outcomes and efficiency, and to find ways to improve. So far, we’ve entered information from more than 10,000 patients into the registry. This data gathering starts as soon as a patient presents, and continues through treatment and follow up. The information includes everything from a patient’s demographic profile to their imaging results, treatment details and outcome.

Tracking Outcomes, Improving Processes

Key members of our team meet regularly to analyze this data. For instance, our telestroke nurses, air medical crew and admissions team gather every Friday to discuss patient transfer data. By merging our data with Microsoft’s Power BI tool, we can view targeted charts, graphs and reports; evaluate the transfer process; and spot potential improvements.

Reduced Door-to-Needle Time

Meetings like this helped us refine key processes, including our tPA protocol. We used Power BI to analyze how long every step in the tPA process took. This revealed barriers including an inefficient patient flow that required patients to be routed to the trauma bay, then to CT, then back to a room in the ED.

We streamlined the process by removing the initial trip to the trauma bay. Now, EMS transports patients directly to CT, and then tPA is administered within the radiology area.

Thanks to this change, we’re now treating 84% of our stroke patients in 60 minutes or less, and 66% are treated in 45 minutes or less. That’s significantly better than the American Heart Association/American Stroke Association guidelines, which call for 75% within 60 minutes, and 50% within 45 minutes.

Expedited Transfers

The Code Stroke Registry also links with a cloud network to help expedite transfers when patients need advanced care like mechanical thrombectomy.

Patients at our partner hospitals automatically have their CT scan uploaded to the Code Stroke Registry and then read by our telestroke nurses. The nurses contact our team if the patient needs to be routed to Atrium Health for advanced care.

We can then reach out to the hospital, rather than waiting for them to call us. This can make a huge difference in outcomes for something as time-sensitive as stroke.

Data-Driven Decisions

We don’t just want to track outcomes – we want to predict them. That’s why we’re building a tool that uses past data to anticipate how a current patient might respond to treatment. The tool will let us enter a patient’s clinical demographics, and CTA and CT perfusion results. Then it will show how similar patients were treated and what results they had.

We’re hopeful this will help us make faster, data-driven decisions about treatments, while offering patients and families a realistic sense of how they might fare.

Help Us Shape the Future of Stroke Care

Our hope is that the Code Stroke Registry can improve outcomes and be a model for other health systems – and we’re excited to trade ideas with you about even more powerful ways that data can elevate care.

To learn more about our Code Stroke Registry, email Andrew Asimos, MD at Andrew.Asimos@AtriumHealth.org.

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