“We want to ensure that patients have all they need when they leave the hospital to successfully continue their recovery at home – education, medications and a phone number to call if there are any problems,” said Paula Gisler, administrative director of the .

U Care was developed in partnership with , a subsidiary of Kindred Healthcare, to follow up with patients after they leave the hospital. Registered nurses with U Care reach out to patients by phone on a regular schedule to monitor the patients’ recovery progress, check their medications, ensure they have made appropriate follow-up appointments and answer any questions or health concerns that arise. The nurses have access to the patients’ health records and can escalate any concerns to hospital staff or physicians if a patient requires further clarification or intervention. The program pilot, which began in June, will follow 250 stroke patients for 45 days after discharge, whether they went home or to a rehab facility for recovery.

Patients and their families also may call the nurses at U Care if they have questions or concerns related to their stroke. In addition, the program will record levels of patient satisfaction at the rehab centers.

“At UofL Hospital, we continually strive for excellence in the acute treatment of stroke patients,” said Kerri Remmel, MD, PhD, medical director of the UofL Hospital Stroke Center and chair of the UofL Department of Neurology. “U Care adds the vital step of thoroughly programmed follow-up with stroke patients to ensure they continue recovery, avoid unnecessary readmission to the hospital and prevent a second stroke.”

Lacuna Health administers U Care for the hospital, and is monitoring its success to make further improvements and to adapt the program to other patient populations.

“We are thrilled to support the University of Louisville Hospital – Comprehensive Stroke Center’s U Care program with our RN-led clinical AfterCare model. Patients and their caregivers need more resources and ongoing support when managing the transition from a hospitalization to another setting or home. We look forward to implementing this model and future programs to help UofL Hospital provide a differentiated patient experience for the communities it serves,” said Brian Holzer, MD, MBA, CEO of Lacuna Health.

U Care is yet another innovation in quality stroke care by the staff at the UofL Hospital, the first hospital designated as a comprehensive stroke center in Kentucky by the Joint Commission. In addition, UofL Hospital once again has been awarded the top level of distinction by the American Heart Association/American Stroke Association with the Get With The Guidelines® Target: Stroke Elite Plus, Gold Plus award. The award recognizes the hospital’s success in providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence. Hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods and achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke Quality measures to receive the Gold Plus Quality Achievement Award.

UofL Hospital has achieved the highest recognitions for stroke care for 12 years.

As the state’s first , UofL Hospital meets the highest standards of stroke care, and continually raises the bar. Prompt treatment with intravenous Alteplase (IV t-PA) is associated with better outcomes, lower mortality and shorter length of stay for patients with ischemic stroke. One of the key stroke treatment guidelines established by the American Heart Association and American Stroke Association is the administration of IV t-PA within 60 minutes of arrival at the hospital for patients with ischemic stroke. The staff at UofL Hospital continually works to improve this time, aiming to deliver IV t-PA to eligible patients within 45 minutes.  

Deidra Gottbrath, RN, BSN, leads a team of specialized stroke clinical resource nurses on staff at UofL Hospital to help ensure that eligible stroke patients receive IV-tPA as quickly as possible. It can be challenging to determine whether a patient’s symptoms are due to a stroke or another condition. Gottbrath, who is certified in critical care and stroke care, provides the added resource to help expedite this process.

“From the moment we start participating in care, the ultimate focus becomes treating the stroke. That sounds simple, but there are a lot of complex cases that involve stroke symptoms,” Gottbrath said. “We don’t wait until we are sure it is a stroke before we apply that urgency. We focus on treating every case with stroke symptoms as though it is a stroke until we firmly rule out a stroke and let go of that urgency.”

Paula Gisler, RN, PhD, is director of the UofL Hospital Stroke Program and helped define the stroke clinical resource nurses’ role. “These nurses are a resource to patients and physicians to drive care for all stroke patients. They do whatever it takes to get stroke patients appropriate care to achieve the best outcomes.”

The stroke clinical resource nurse supports emergency room nurses to assess potential stroke patients, facilitate scans, get IV-tPA medication prepared, and work with family members. They keep lines of communication flowing among emergency room nurses, doctors, the stroke team, the radiology staff and other providers.

“We are the string that ties the story together so it makes a complete circle, rather than leaving threads that might be woven together later,” Gottbrath said. “Because we focus solely on that one patient and situation, because that is our priority, we can offer the resource of locating family members to get the full story to get the patient treatment.”

Gottbrath and the other stroke clinical resource nurses follow patients beyond the emergency room, advocating for patients and keeping the lines of communication open throughout their stay. They provide education for patients and their families, as well as bedside nurses who care for stroke patients outside of the stroke unit.

“We are involved in the daily discussions of what type of rehab is appropriate for a patient and communicating that back to the families,” Gottbrath said. “We are there from the scariest moment to looking forward to going home or to rehab. We see the full circle of care.”

Kerri Remmel, MD, PhD, director of the UofL Hospital Stroke Center and chair of the UofL Department of Neurology, says Gottbrath and her colleagues are invaluable assets to stroke care.

“Deidra and the other stroke clinical resource nurses provide an exceptional service to our patients,” Remmel said. “They are vital in keeping the focus on stroke care for those patients and making the connections that have led to even more improvements in the care we provide.”

Door-to-needle times reduced 

Gottbrath and Tina Walsh, RN, BSN, another stroke clinical resource nurse at UofL Hospital, compiled research data showing that since the introduction of stroke clinical operations nurses in 2016, door-to-needle times at UofL Hospital have shortened by an average of 2.5 minutes for eligible patients receiving IV t-PA at the hospital. In addition, eligible patients receiving IV t-PA within 45 minutes of arrival increased from 37 to 49 percent. Gottbrath presented the data at the International Stroke Conference earlier this year.

Although the UofL program does not yet have stroke nurses on duty around the clock, having these nurses in the hospital has led to faster door-to-needle times even when a stroke nurse is not in the building.

“This position has encouraged and educated the staff so that even when we are not physically present, stroke care is fresh on people’s minds – they remember the urgency of it,” Gottbrath said.

Gisler expects UofL Hospital will have a stroke clinical resource nurses on duty around the clock by the end of 2018.

A native of southern Indiana, Gottbrath originally planned to become a physician, but she did not feel as engaged in that career path as she expected. She followed her sister’s suggestion to try nursing and discovered it gave her the interaction with patients that she enjoyed.

“As I delved into it, I felt more connected to nursing,” she said. “The minute I started nursing school I thought, ‘This is what I’ve been missing. This is the connection to medicine I always wanted.’”

“Every day is so different and so challenging but so rewarding. Now I can’t image doing something different.”