Jun-O'Connell Adalia H, Grigoriciuc Eliza, Gulati Akanksha, Silver Brian, Kobayashi Kimiyoshi J, Moonis Majaz, Henninger Nils
Departments of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Departments of Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States.
Front Neurol. 2023 Jun 15;14:1205487. doi: 10.3389/fneur.2023.1205487. eCollection 2023.
Unplanned 30-day hospital readmissions following a stroke is a serious quality and safety issue in the United States. The transition period between the hospital discharge and ambulatory follow-up is viewed as a vulnerable period in which medication errors and loss of follow-up plans can potentially occur. We sought to determine whether unplanned 30-day readmission in stroke patients treated with thrombolysis can be reduced with the utilization of a stroke nurse navigator team during the transition period.
We included 447 consecutive stroke patients treated with thrombolysis from an institutional stroke registry between January 2018 and December 2021. The control group consisted of 287 patients before the stroke nurse navigator team implementation between January 2018 and August 2020. The intervention group consisted of 160 patients after the implementation between September 2020 and December 2021. The stroke nurse navigator interventions included medication reviews, hospitalization course review, stroke education, and review of outpatient follow-ups within 3 days following the hospital discharge.
Overall, baseline patient characteristics (age, gender, index admission NIHSS, and pre-admission mRS), stroke risk factors, medication usage, and length of hospital stay were similar in control vs. intervention groups ( > 0.05). Differences included higher mechanical thrombectomy utilization (35.6 vs. 24.7%, = 0.016), lower pre-admission oral anticoagulant use (1.3 vs. 5.6%, = 0.025), and less frequent history of stroke/TIA (14.4 vs. 27.5%, = 0.001) in the implementation group. Based on an unadjusted Kaplan-Meier analysis, 30-day unplanned readmission rates were lower during the implementation period (log-rank = 0.029). After adjustment for pertinent confounders including age, gender, pre-admission mRS, oral anticoagulant use, and COVID-19 diagnosis, the nurse navigator implementation remained independently associated with lower hazards of unplanned 30-day readmission (adjusted HR 0.48, 95% CI 0.23-0.99, = 0.046).
The utilization of a stroke nurse navigator team reduced unplanned 30-day readmissions in stroke patients treated with thrombolysis. Further studies are warranted to determine the extent of the results of stroke patients not treated with thrombolysis and to better understand the relationship between resource utilization during the transition period from discharge and quality outcomes in stroke.
在美国，中风后30天内非计划再次入院是一个严重的质量和安全问题。出院与门诊随访之间的过渡期被视为一个脆弱时期，在此期间可能会发生用药错误和随访计划缺失的情况。我们试图确定在过渡期利用中风护士导航团队是否可以降低接受溶栓治疗的中风患者30天内非计划再次入院的发生率。
我们纳入了2018年1月至2021年12月期间机构中风登记处连续447例接受溶栓治疗的中风患者。对照组包括2018年1月至2020年8月中风护士导航团队实施前的287例患者。干预组包括2020年9月至2021年12月实施后的160例患者。中风护士导航干预措施包括药物审查、住院过程审查、中风教育以及出院后3天内的门诊随访审查。
总体而言，对照组和干预组的基线患者特征（年龄、性别、首次入院美国国立卫生研究院卒中量表评分和入院前改良Rankin量表评分）、中风危险因素、药物使用情况和住院时间相似（P>0.05）。差异包括实施组机械取栓使用率更高（35.6%对24.7%，P=0.016）、入院前口服抗凝剂使用率更低（1.3%对5.6%，P=0.025）以及中风/短暂性脑缺血发作病史频率更低（14.4%对27.5%，P=0.001）。基于未调整的Kaplan-Meier分析，实施期间30天非计划再次入院率较低（对数秩检验P=0.029）。在对包括年龄、性别、入院前改良Rankin量表评分、口服抗凝剂使用情况和新冠病毒诊断等相关混杂因素进行调整后，护士导航的实施仍与30天非计划再次入院的较低风险独立相关（调整后风险比0.48，95%置信区间0.23-0.99，P=0.046）。
中风护士导航团队的使用降低了接受溶栓治疗的中风患者30天内非计划再次入院的发生率。有必要进行进一步研究以确定未接受溶栓治疗的中风患者的结果程度，并更好地理解出院过渡期资源利用与中风质量结果之间的关系。
