Quality, Safety, and Cost Considerations
Part 1
A stroke occurs when the blood supply to the brain is interrupted or reduced, resulting in a low nutrient and oxygen supply to the brain (Khouri et al., 2017). A stroke can cause brain cells to die, and it is a medical emergency that requires immediate medical intervention. In 2016, one out of six mortalities from cardiovascular diseases was due to stroke (CDC, 2021). Every year, 795,000 individuals suffer from stroke (CDC, 2021). Stroke is costly to manage, and it leads to low quality of life and mortality.
Quality of Care
Stroke patients have a right to receive quality care. 795,000 Americans have a stroke annually (CDC, 2021). Stroke patients must receive healthcare services that meet their complex healthcare needs. Quality of care is “the degree to which healthcare services for patients enhance the probability of desired healthcare outcomes and are consistent with current evidence-based practice guidelines” (World Health Organization, 2020). In the context of stroke care, the quality of care will be related to healthcare outcomes, which include disability or death. It is also related to the characteristics of available healthcare services. In terms of stroke care, it includes access to radiological investigations by patients. The third aspect of the quality of stroke care is related to the structure of care. This will include equipment, facilities, services, and qualified personnel to manage stroke patients. Availability of quality trained multidisciplinary healthcare team to manage stroke patients. Stroke results in mortality, morbidity, and complications to patients, significantly reducing their quality of life (Khouri et al., 2017).
Improving Quality of Care
Many strategies can be utilized to improve the quality of stroke care. These strategies include providing adequate medical infrastructure, using technology, developing standardized practice guidelines, and promoting multidisciplinary team care (Baatiema et al., 2020). Other strategies include professional development and public awareness campaigns. Competency-based training in acute stroke care is essential in improving stroke care. Healthcare professionals should be trained on treatment protocols and stroke algorithms (Baatiema et al., 2020). Training should be prioritized on stroke care to help the staff deliver quality care to enhance patient outcomes.
Another strategy to enhance the quality of stroke care is to ensure adequate resources to deliver stroke care. This should include increased access to medical logistics, infrastructure, and laboratory and neurosurgical services (Baatiema et al., 2020). Medical personnel should also be enough to handle stroke patients with complex healthcare needs. Another strategy is a multidisciplinary approach to care. A multidisciplinary team will develop joint healthcare plans and foster effective communication (Baatiema et al., 2020). This will improve the quality of healthcare services. Another strategy will be the digitization of clinical practice. Clinical information should be stored and retrieved electronically to support optimal decision-making (Baatiema et al., 2020).
Patient Safety
Stroke is a leading cause of mortality and morbidity in adults. Stroke is a serious and common healthcare disorder, and patients can suffer from severe complications. These complications can happen at any time during their hospital stay. Many medical studies have revealed that complications are common in stroke patients. The frequency of stroke complications ranges from 40 to 96% of patients (Tamburri et al., 2020). Safety is Patients who have survived stroke attacks have deficits linked to nutrition, mobility, mood, cognition, and immunity (Tamburri et al., 2020). The post-stroke complications and residual stroke effects negatively affect patient safety, putting the patients at more risk of further injury. Safety is a major for stroke patients since the medical complications can increase the length of hospital stay and healthcare costs and are directly linked with worse healthcare outcomes (Tamburri et al., 2020). In addition, most of these complications are treatable and potentially preventable if promptly identified. To develop healthcare plans, healthcare professionals must understand the complex healthcare needs to help enhance critical care.
Improving Patient Safety
Stroke-specific interventions and stroke physiology can enable healthcare professionals to reduce the risk of dysphagia, malnutrition falls, device-related infections, depression, aspiration pneumonia, dehydration, and altered glucose metabolism (Tamburri et al., 2020). This will help to enhance patient safety. A multidisciplinary team approach to care is another key strategy to enhance patient safety. Endovascular therapies are increasingly used in stroke care, requiring multidisciplinary decision-making involving anesthetists, neurointensive care specialists, and neurointerventionalists (Bohmann et al., 2021). This will lead to increased handover numbers and larger team sizes, which shows that teamwork is critical in enhancing patient safety. Improving communication is critical in reducing errors in stroke care. To improve communication, hospitals should implement policies to promote healthcare information exchange in an organized manner. The staff should communicate systematically to ensure critical healthcare information is relayed correctly.
Cost
Stroke is one of the top ten contributors to Medicare costs (Johnson et al., 2016). The stroke burden is expected to increase due to the aging population. The costs associated with stroke include healthcare and long-term direct and indirect costs related to lost productivity and rehabilitation (Johnson et al., 2016). The mean lifetime cost of ischemic stroke in the US is approximately 140,048 USD (Johnson et al., 2016). In 2008, the cost of lost productivity was 15.5 B USD, while the direct cost of treating stroke was 18.8 B USD (). Currently, the US’s total indirect and direct annual costs are approximated to be between 36.5 and 65B USD, which is expected to surpass 180B USD by 2030 (Johnson et al., 2016). Direct costs related to stroke include hospitalizations, nursing home admissions, physician fees, medications, medical equipment, rehabilitative services, and home care (Johnson et al., 2016). Caring for stroke survivors has a significant economic burden on individuals and the community.
Reducing Costs
The first strategy for reducing stroke spending is by reducing vascular risk by using cardioprotective medications. Combining antihypertensives, antiplatelets, and statin reduces the risk of stroke by more than half and saves costs in high-risk patients (Kalanithi et al., 2014). The second strategy is to relocate care for low-risk patients from the hospitals to outpatient settings. Outpatient settings for low-risk stroke patients can achieve the same healthcare outcomes similar to hospitals at lower costs. Outpatient clinics can achieve savings of ≥$4000 compared to hospital care (Kalanithi et al., 2014). The third strategy can be to enhance the transition from post-discharge care to reduce post-stroke admissions. Patients vulnerable to readmission should have health coaching and timely outpatient follow-up to reduce readmission risks (Kalanithi et al., 2014).
Government Policy
The government policy that will impact stroke care is the Affordable Care Act (ACA). This act was enacted in 2010. Since its enactment, ACA has resulted in enhanced access to healthcare services, and it has also reduced healthcare costs. The act has expanded Medicaid coverage, and individuals who have low incomes can now access healthcare services (McIntyre & Song, 2019). The act has also expanded insurance coverage for those who did not have insurance. This act thus directly impacts the management of stroke. Nurses can manage stroke patients effectively since they can now access healthcare services. Individuals can access healthcare services despite preexisting conditions (McIntyre & Song, 2019). ACA also encourages healthcare professionals to implement preventive healthcare services such as patient education. This will help in stroke management since it will prevent stroke complications, enhance patient safety, and enhance healthcare outcomes.
Part 2
I met Mrs. Tammaro, an 84-year-old Caucasian female. She was diagnosed with hypertension ten years ago, and she recently suffered an ischemic stroke four months ago. This left her with cognitive issues such as short-term memory impairment. I learned from this patient that he did not adhere to the medication schedule despite being counseled on medication adherence. The patient stated that her non-adherence was because she was taking so many medications that also had side effects. I reviewed the American Heart Association website. I learned that stroke is one of the leading causes of mortalities in the United States. It is also associated with many healthcare complications that can be easily treated or prevented if recognized early. The main barrier I had with this patient was medical illiteracy. The patient, however, noted that she had learned the importance of medication adherence in the prevention of stroke complications. I used a democratic style to overcome this barrier. I listened to the patient’s opinion and discussed it with her openly. We agreed and developed a care plan together. I did not make any changes; if I were to do this again, I would do it the same way.
References
Baatiema, L., De‐Graft Aikins, A., Sarfo, F. S., Abimbola, S., Ganle, J. K., & Somerset, S. (2020). Improving the quality of care for people with a stroke in a low‐/middle‐income country: A qualitative analysis of healthcare professionals’ perspectives. Health Expectations, 23(2), 450-460. https://doi.org/10.1111/hex.13027
Bohmann, F. O., Guenther, J., Gruber, K., Manser, T., Steinmetz, H., & Pfeilschifter, W. (2021). Measuring patient safety climate in acute stroke therapy. Frontiers in Neurology, 12. https://doi.org/10.3389/fneur.2021.686649
CDC.(2021,May,25). Strokefacts.Centers. For.Disease.Control and Prevention. https://www.cdc.gov/stroke/facts.htm
Johnson, B., Bonafede, M., & Watson, C. (2016). Short- and longer-term healthcare resource utilization and costs associated with acute ischemic stroke. ClinicoEconomics and Outcomes Research, 53. https://doi.org/10.2147/ceor.s95662
Kalanithi, L., Tai, W., Conley, J., Platchek, T., Zulman, D., & Milstein, A. (2014). Better health, less spending. Stroke, 45(10), 3105-3111. https://doi.org/10.1161/strokeaha.114.006236
Khouri, G., Ozark, S., & Ovbiagele, B. (2017). Common risk factors for stroke and medical prevention therapies. OxfordMedicineOnline. https://doi.org/10.1093/med/9780199937837.003.0103
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine, 16(2), e1002752. https://doi.org/10.1371/journal.pmed.1002752
Tamburri, L. M., Hollender, K. D., & Orzano, D. (2020). Protecting patient safety and preventing modifiable complications after acute ischemic stroke. Critical Care Nurse, 40(1), 56-65. https://doi.org/10.4037/ccn2020859
World Health Organization. (2020, July 21). Quality of care. WHO | World Health Organization. https://www.who.int/health-topics/quality-of-care#tab=tab_1
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Question 
In a 5-7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately two direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with the subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or groups in the Core Elms Volunteer Experience Form. Report on your experiences during your first two practicum hours.
Quality, Safety, and Cost Considerations
Introduction
Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience, can prioritize time, resources, and finances. Healthcare organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are critical to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.
Preparation
In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least two direct practicum hours working with the same patient, family, or group. You may also consult with subject matter and industry experts during this time.
To prepare for the assessment:
Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete and how it will be assessed.
Conduct scholarly and professional literature research to inform your assessment and meet scholarly expectations for supporting evidence.
Review the Practicum Focus Sheet: Assessment 2 [PDF], which guides conducting this portion of your practicum.
Note: Remember that you can submit all or a portion of your draft assessment to Smarthinking for feedback before you submit the final version. If you plan on using this free service, be mindful of the 24–48 hours turnaround time for receiving feedback.
Instructions
Complete this assessment in two parts.
Part 1
Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least two practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or groups in the Core Elms Volunteer Experience Form. Use the Practicum Focus Sheet: Assessment 2 [PDF] provided for this assessment to guide your work and interpersonal interactions.
Part 2
Report on your experiences during your first two practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.
Who did you meet with?
What did you learn from them?
Comment on the evidence-based practice (EBP) documents or websites you reviewed.
What did you learn from that review?
Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
What barriers did you encounter when presenting the problem to the patient, family, or group?
Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
What changes, if any, did you make to your definition of the problem based on your discussions?
What might you have done differently?
CORE ELMS
Update the number of hours on the NURS-FPX4900 Volunteer Experience Form in CORE ELMS.
Requirements
The assessment requirements below correspond to the scoring guide criteria, so address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format, length, and supporting evidence.
Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Cite evidence that supports the stated impact.
Note whether the supporting evidence is consistent with what you see in your nursing practice.
Explain how state board nursing practice standards and organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Describe research that has tested the effectiveness of these standards and policies in addressing care quality, patient safety, and costs to the system and individual.
Explain how these standards and policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice within the context of care quality, patient safety, and cost to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individuals.
Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individuals.
Identify relevant and available benchmark data sources on care quality, patient safety, and costs to the system and individual.
Document the time spent (your practicum hours) with these individuals or groups in the Core Elms Volunteer Experience Form.
Use paraphrasing and summarization to represent ideas from external sources.
Apply APA style and formatting to scholarly writing.
Additional Requirements
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you write and format your paper. Be sure to include:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5–7 pages long, not including the reference page.
Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
Proofreading: Proofread your paper before you submit it to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
Competencies Measured
By completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individuals. Document the practicum hours spent with these individuals or groups in the Core Elms Volunteer Experience Form.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.
Competency 8: Integrate professional standards and values into practice.
Use paraphrasing and summarization to represent ideas from external sources.