Abstract Body (Do not enter title and authors here): Introduction
Organized patient follow up is noted to have a significant impact on mortality. Stroke patients often require complex post-discharge management in an outpatient setting. At this Comprehensive Stroke Center, stroke patients are to receive a 30-day, 90 day, and 1 year appointment in the Stroke Clinic. However, post-acute follow up appointments are typically established after discharge, leading to scheduling delays for the 30-day appointment, patients lost to follow up or no showing to appointments. Stroke Navigators are an emerging role that can bridge the gap between acute and post-acute care settings and are integral to ensuring stroke patients receive optimal follow up care.
Methods
In 2022, a Stroke Navigator was added to the care team and collaborated with the Stroke Clinic to project volume of clinic slots needed for expected ischemic and TIA hospital discharges. The Stroke Navigator implemented follow up scheduling with the patient/family prior to discharge and emphasized the importance of the 30-day appointment. Preintervention and postintervention data was then collected and analyzed from Q2 2022 to Q1 2023 regarding timeliness of scheduling, appointment type, and rate of no shows for all ischemic stroke/TIA patients.
Results
The pre-intervention scheduling process resulted in an average wait time of 19 days to schedule appointments. Post intervention, virtually no wait time was identified as appointments were mostly scheduled prior to discharge. Pre-intervention data on 30-day appointments showed that only 23% of patients were scheduled and attended their provider visit, while post-intervention data showed 60%. The clinic no show rate went from 19%, down to 10% in the post intervention phase.
Conclusion
The Stroke Navigator has made a significant impact on the number of patients with 30-day visits, eliminated the wait time for appointments due to scheduling prior to discharge, increased the number of appointments visible on discharge paperwork, and decreased the no show rate for patients at 30 days. This emphasizes the impact of nurse lead initiatives on the overall health of a community. Further data analysis will include the impact of telehealth versus in-person appointment compliance . Additionally, review beyond the 30 day appointments to include 90 day and 1 year appointments. Financial analysis will also be critical to validate the impact of a Stroke Navigator, as they are an essential team member in closing the gap in post-acute care.