As a new Stroke Coordinator at St. Dominic Hospital in Jackson, Mississippi, I was oriented to the Joint Commission guidelines and to a program called Get With The Guidelines. Apparently, these were the rules I had to live by in my new position. No longer than a week into my orientation, I was introduced to an Interventional Radiologist who had been to the CLOTS course. He taught me about INSTOR. He also approached our hospital administration and insisted that we participate in the INSTOR stroke registry. At the time, I didn’t really see the big picture… but it didn’t take very long until the big picture was very clear.
The thing that INSTOR helps me with is the evaluation of the process by which patients are treated and their outcomes. Of course, these are the two most important elements of any successful stroke center. We need to make sure that our patients are treated in a timely manner, with the most appropriate, evidenced-based treatment options, and that patient selection criteria are in place to ensure optimal outcomes. The data collected in INSTOR is our way to evaluate each of these components.
How do we get it done?? Here at St. Dominic’s, we enter all of our “Stroke Alert” patients into INSTOR, not every single stroke patient. By entering all of our “Stroke Alert” patients, we can filter through all aspects of the care of the patient. Of course, there is more data to be entered on the cases that receive intervention. This is fine, because that’s how we learn. And, there is more data to collect when we have a busier month or provide more acute stroke treatment. So here is an average month: 60 stroke patients, 20 – 25 stroke alerts, 4-5 IV TPAs, 2- 4 interventional cases. I have an on-the job trained clerical worker that enters every case. She spends 4 hours / month on INSTOR. I go back and add the more crucial, clinical information only on the patients who were treated. I spend (maybe) 2 hours/ month. I also go back and enter the outcomes.
We get all of our information out of the EMR. The ER staff and the IR staff have a form we designed that documents the information that I need and then I harvest the information. Besides the enrollment fee, the manpower cost runs about $150 – $200 a month.
There is no way to truly measure the return on investment. It has made the difference between being a run of the mill stroke center and being one of the best. Now we know what exactly is happening during our stroke cases.