Simple Interventions Improve Compliance With Patient-Specific Stroke Discharge Instructions

Marian LaMonte, MD, MSN, FAAN

A recent study improved hospital compliance of providing patient-specific stroke discharge instructions (DCI) by implementing simple educational and decision support interventions. These findings were presented virtually at the 2021 American Academy of Neurology (AAN) Annual Meeting, April 17-22, by Marian LaMonte, MD, MSN, FAAN, chief of neurology, Ascension Saint Agnes. 

LaMonte and colleagues sought to "increase provider compliance rate in the use of stroke specific DCI by 15% which will provide patients with accurate and practical information at the time of discharge to improve their understanding of stroke. Through this we aim to foster patient engagement in the rehabilitation phase of poststroke care and decrease the risk of recurrent stroke by improving compliance with guideline recommended therapies,” they wrote.

LaMonte and colleagues conducted a review of the stroke database at Ascension Saint Agnes pre-intervention as a baseline for physician compliance with stroke specific DCI from June to September 2019. In October 2019, they executed an intervention bundle consisting of simple educational activities and reminders/decision support tools embedded in the EMR. They reviewed the intervention from November 2019 through March 2020. 

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“Many hospitals, it turns out, have a very difficult time ensuring that patient discharge instructions are specific to an individual patient's risk factors, rather than just general information about stroke that might not pertain directly to their own issues that they need to address for future health,” LaMonte told NeurologyLive in an accompanying interview.

The researchers found that the intervention bundle increased compliance with the use of stroke specific DCI by 38.6%, from 51.9% pre-intervention to 90.5% within 4 months of intervention. Improvements in compliance were seen in the teaching service, from 60% to 90.5% and non-teaching service from 25% to 87.5%.

Stroke currently stands as a leading cause of long-term disability in elderly adults in the US, LaMonte and colleagues noted, adding that recovering from these rates will require improvements in a number of areas, namely education, support, skill training, and counseling. This is particularly true as literature suggests that survivors of stroke tend to not reach their goals for rehabilitation, with limited information often proving as an obstacle. “Having dedicated stroke DCI is one tool that hospitals can leverage to improve patient’s knowledge,” they wrote. 

“We try to provide, in writing, to a patient and their family, the specific risk factors that we have uncovered while they've been in the hospital that we think are associated with their stroke. We advise how you can treat them and which medicines they should be on for these risk factors—your medication list and what each medicine is used for to combat your risk factors for stroke. And what they can do just generally, to have a healthier lifestyle to reduce their risk of stroke,” LaMonte told NeurologyLive.

For more coverage of AAN 2021, click here.

REFERENCE

Asfaw M, LaMonte M. Improving stroke patient discharge instructions use. Presented at 2021 American Academy of Neurology Annual Meeting; April 17-22. Abstract P5 119