Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program

You know what would work even better to reduce readmissions? Going to the original cause. Stopping the neuronal cascade of death. Does no one in stroke have two functioning neurons to rub together?
http://stroke.ahajournals.org/content/early/2016/04/28/STROKEAHA.115.012524.abstract

1. Christina Condon, MSN, NP,
2. Sarah Lycan, MSN, NP,
3. Pamela Duncan, PhD, PT and
4. Cheryl Bushnell, MD, MHS

+ Author Affiliations

1. From the Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC.

1. Correspondence to Cheryl Bushnell, MD, MHS, Department of Neurology, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston Salem, NC 27157. E-mail cbushnel@wakehealth.edu

1. Presented in part at the International Stroke Conference, Los Angeles, CA, February 17–19, 2016.

Abstract

Background and Purpose—Our aim was to determine whether a standardized Transitional Stroke Clinic (TSC) led by nurse practitioners could reduce 30-day and 90-day readmissions for stroke or transient ischemic attack patients discharged home.

Methods—Phase I consisted of nurse practitioners calling only high-risk patients discharged home within 7 days and performing an office visit within 2 to 4 weeks of discharge. Phase II consisted of all patients discharged home receiving both a 2-day follow-up phone call by a registered nurse and a follow-up visit with a nurse practitioner within 7 to 14 days. Differences in process metrics and readmissions across the 2 phases and overall were assessed. Increasing complexity with multiple chronic conditions (diabetes mellitus, coronary artery disease, and congestive heart failure) was represented in a continuous variable from 0 to 3. Multivariable logistic regression models for 30-day and 90-day readmissions were performed with adjustment for National Institutes of Health Stroke Scale (NIHSS) and previous hospitalizations.

Results—From October 2012 through September 2015, 510 patients were enrolled. From phase I to II, a higher proportion of follow-up calls were made and days from discharge to TSC decreased. Patients readmitted within 30 days were less likely to show for TSC visits (60.85% versus 76.3%; P=0.021). Multivariable modeling showed that TSC visit was associated with a 48% reduction in 30-day readmission (odds ratio, 0.518; 95% confidence interval, 0.272–0.986), whereas multiple chronic conditions and previous stroke/transient ischemic attack increased the risk. TSC visit did not impact 90-day readmissions.

Conclusions—Evaluation in a nurse practitioner–led structured clinic is a model that may reduce readmissions at 30 days for stroke patients discharged home.