The Role of a Stroke Coordinator with Monte Moos-Jenkins| E. 65

Every year, nearly 800,000 people in the United States have a stroke. Listen in to a Stroke Coordinator on how his role helps to save lives, transform patient care, and reduce costs.

Episode Introduction 

Monte explains why data abstraction is the biggest part of a stroke coordinator’s role, the importance of maintaining patient focus and why ‘’responsibility without authority’’ means teamwork and communication are vital. He also highlights his unique position in understanding the time sensitive nature of treating stroke patients, and how patient arrival time dropped by 100 minutes following a community awareness campaign.

 

Show Topics

 

Data abstraction is the biggest factor for a stroke coordinator 

Ensuring patient follow-up for better patient care

Making a difference as a stroke coordinator

The ads that transformed patient education

Why teamwork and communication is a must 

The cost savings benefits of hiring a stroke coordinator

Leadership is about helping others to succeed

 

 

07:47 Data abstraction is the biggest factor for a stroke coordinator

Monte explained the ‘’life-changing’’ impact of data abstraction on his role and ability to improve patient care. 

‘’The largest part of being a stroke coordinator is data abstraction. There is tons of data abstraction. It's incredibly time-consuming. There's information that I have to gather on every single patient that arrives with stroke-like symptoms. That is probably two to three times the amount of patients that actually become stroke patients. So it's a huge number of patients. So every code stroke in the hospital, which sometimes there's two, three, four a day, those are patients that I have to do data abstraction on. Then I also have to understand how the data determines opportunities for improvement, and that was something I was so completely unaware of as a regular nurse. I was just working in the hospital. Data seemed, it used to make me angry when someone would come at me with data because I'm like, "I don't care about your data. All I care about is the patient. So then I learned that data actually drives this change, and so I learned how data drives the change, and it's been really, really fascinating and very life-changing for me and being able to look at things and say, "Oh, here's where we can make improvements for these patients."

 

11:15 Ensuring patient follow-up for better patient care

Monte said that arranging neurology appointments for all stroke and TIA patients was another key element of the stroke coordinator’s role.

‘’Right now we're providing neurology appointments for all of our stroke and TIA patients. So I spend a lot of time going back and forth with their office to create those appointments and tracking those. There's just tons of tracking of everything. …..that's something …. that we just started doing this last year. We just started doing the TIA patients first, and then we added all the stroke patients in. So that way they have follow up outside of the hospital once they go home. Because a lot of people went home and they didn't follow up with someone and we found that if we create their appointment for them before they leave or even shortly after they leave, then they're more likely to go to the appointment.’’

 

12:44 Making a difference as a stroke coordinator

Monte said the stroke coordinator is vital for stroke centers to receive certification and in ensuring rapid treatment of patients. 

‘’Well, number one, the easiest one to tell you is to be a designated stroke receiving center by the county. We have to be a stroke certified hospital, so we can't lose that certification. So in other words, in order to be that receiving center, what a designated receiving center is? Well, when someone picks up the phone and calls 911 and the patient has stroke-like symptoms, they immediately go to our hospital if it's the closest hospital to them because we are the stroke center. Now in Monterey, two of them, and one is on the west side of the county, one's on the east side, we're on the east side, and we don't fight over patients. There's no argument or anything. It's just split right down the middle. And so if they're on the east side, they come to us. If they're on the west side, they go to them. But that is one of the biggest things, is if we didn't have that designation, we would lose a lot of patients to another stroke center. And the other thing is for cardiac, we always heard time is muscle, the second is true for stroke, time is brain. And people don't realize that approximately 1.9 million neurons die every minute during a large vessel occlusion. So we are racing, when they first come in, we are racing to give them treatment to dissolve that clot or whatever else so that we can restore that blood flow back to that area of the brain, because the longer they go without that blood flow, the more brain damage they're going to have. So that is what the whole thing is when they first come in.’’

 

14:10 The ads that transformed patient education 

Monte said the average time for patients arriving at hospital after a stroke dropped by 100 minutes through raising awareness. 

‘’And the other thing where we make a huge difference in the community is because stroke is very time sensitive as far as treatment is concerned, you communicate and teach the community about stroke, stroke symptoms and recognizing those and getting into the hospital as quickly as possible.  My partner, who is the cardiovascular coordinator, he and I have gone back and forth. We've gone to so many community events and everything trying to make a difference, and nothing has really made a difference. All of a sudden one day he said to me, "Why don't we advertise on the side of buses and advertise in the theater?" …… So this is where data comes in handy. If it makes a difference, we're looking at the time someone recognizes their symptom to the time they arrive at the hospital. If it makes a difference, it should be shorter. We did that and it was fascinating. We only ran the ads for three months and we could see that time. The average time dropped almost 100 minutes over those three months, and then after the ads stopped, they slowly started coming back up again. So the next year we thought, okay, this is maybe a fluke. Let's do it at a different time of year, whatever. This time we both did the ads because the bus ads did nothing. We ran both of our ads in the theater, same thing happened within a short time. Those times dropped down over 100 minutes this time. So now we advertise in the theater year round. And we started that and then all of a sudden COVID hit, which was funny, and all the theaters closed. So we had to wait until they opened up again to redo that. But it makes a huge difference to our patient population.’’ 

 

17:52 Why teamwork and communication is essential  

Monte said stroke coordinators have a lot of responsibility but no authority, making communication and teamwork essential. 

‘’So for instance, I want to make a change or something. Any change that I make, it will require someone else or some other department in order to make that change. So if I make a change in the code stroke process, for instance, it's going to affect the ER physicians, the ER nurses, the lab techs, CT techs and EMS. All of those people and all of them have to be involved in that change. So you really create buy-in and get people to understand why we're making this change and why it's so important. So for instance, we brought the MEND exam, which is a stroke neurological exam. You to go back, be educated in Miami and have four other people be educated as well, and then bring the class to our hospital and start teaching that class in the hospital. But in order to get our nurses to actually learn the MEND exam, we had to release a health stream for everyone to do it because we couldn't require that advanced stroke life support be taught to them, which teaches the MEND exam, because the union. So if we want to make it mandatory for say, the stroke unit or ER or ICU, we have to go to the union and have that negotiated into the contract for those things. So these are the things that requires a lot of time communication and working with every single person involved. Right now we're bringing in new drugs. We're bringing in ANDEXXA, which is a reversal agent for apixaban and Rivaroxaban. That included our physicians, our nurses, our clinical informatics to write the order sets. And coming up, we're going to be bringing connect to place in. So we're going to have to go through the same thing again. So each one of those things requires communication, buy-in from all these departments and everybody being on board. And if I don't have that, it's not going to happen.’’

 

21:04 The cost savings benefits of hiring a stroke coordinator

Monte highlighted the best practices of stroke coordinators that enhance patient care, while saving money. 

‘’Well, first of all, being a stroke designated center by the county brings those patients there. So that immediately brings patients that we wouldn't normally receive. But how we help our patients is, for instance, we know that and studies have shown that for every 15 minutes we can shave off of the time that symptoms have started to the time they get treatment, the patient is that much more likely to walk out of the hospital as opposed to going to a skilled nursing facility or rehab event. That is why we put this money into our theaters to bring patients in sooner, because the sooner they get there, the more like they're going to be walk out instead of go to one of these places. That also decreases their length of stay, which it lowers their cost as well as our cost. So each one of these things that we do, we bring best practice to the hospital for stroke, which actually improves our performance. It improves best patient practice and best patient experience.’’

 

27:34 Leadership is about helping others to succeed

Monte said that transparency and honesty can make a big difference to others. 

‘’ I always go back to what I looked at in a leader, and that was someone who was direct, someone who honest, someone who was transparent and someone who just came from a place of love, everything that they do in all of their management style. Those people always made the biggest difference in me. So that's the person I want to be, and I know I'm not always that. Many times I'm not, but that's the person that I want to be and that's what I want to learn. And so I'm constantly striving to do that. And I highly suggest if you are going to go into leadership that you begin to understand that if you make everyone else around you succeed, you are a huge success.’’

 

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You’ll also hear: 

From nursing burnout to stroke coordinator, via teaching and travel nursing, and lessons learned as a branch manager. ‘’I am a Libra, so I tend to be a doormat, and I was a doormat up to that time. And it really taught me that if I'm going to let something go on instead of dealing with it directly and immediately, it's going to come back and bite me in the butt. And that was a really, really good lesson for me and I've learned to be very direct from that.’’

The importance of patient focus. ‘’As long as you keep the patient in focus and everything you're doing for the patient is about the patient and everything you do at work is about the patient, then no one can fault you for that. You just need to keep the patient always at the forefront.’’

Why education matters in the role of stroke coordinator. ’’The interesting thing about being a stroke coordinator, I'm responsible for always updating the knowledge on stroke guidelines for the hospital, any changes in stroke care, all that kind of stuff.. … I have to make sure that education takes place for all of those things.’’

How a mentor helped Monte to listen rather than react ‘’… I think that's why a mentor is so, so important because they can look at you and say, "Calm down. I know you're upset about this and I understand why you're upset about this, but that's not going to do anybody any good."

 

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