| Description |
Background: Stroke remains the second leading cause of death worldwide. Research shows that most strokes have significant modifiable risk factors. Currently primary care settings in the United States lack a systematic stroke risk screening process. It further suggests that stroke risk knowledge amongst primary care providers must improve. As primary care providers are the front line of healthcare system, patients at risk for stroke are commonly seen in such settings first. Patients often present with multiple concerns, making it challenging for providers to evaluate for stroke risk factors. Subsequently, patients with modifiable risk factors may be undermanaged or less educated potentially leading to a primary stroke. The purpose of this quality improvement (QI) project was to increase the amount of stroke risk screenings as well as to improve stroke risk awareness in the primary care setting by using a stroke risk protocol.Methods: This quality improvement project utilized a pre-survey to assess participants' baseline stroke risk knowledge. This survey was used to develop an educational in-service which was presented to all participating clinical staff. The presentation included current data, risk factors, addressed barriers, knowledge gaps, and increased stroke risk awareness. This presentation synthesized information from evidence based literature, and further addressed how to utilize the American Stroke Association's stroke risk scorecard, tally-sheet, flow chart(s), and processes. This presentation was provided to each team member using a PowerPoint presentation and handouts for current and future resource. Pre- and post-educational surveys were performed to assess participant's knowledge of stroke risk assessment. A final post survey was obtained 5 weeks after implementing the project to determine usability, feasibility, satisfaction, and uptake of the stroke risk scorecard. Results: The surveys were fully completed by all participating providers (N=4). All participating providers (N=4, 100%) acknowledged that the stroke risk screening tool was effective and beneficial in stroke risk recognition, while time remained the largest barrier to usage. Each provider (N=4, 100%) endorsed an increase in stroke risk knowledge/awareness following the presentation of the stroke risk protocol. Using a self-reported tally sheet of stroke assignment the providers screened 289 patients from a total of 425 possible visits resulting in a screening rate of 68%. All participating providers (N=4, 100%) reported high usability, feasibility, and overall satisfaction with the stroke risk scorecard and screening protocol. Providers further reported a desire to utilize the stroke risk protocol in their future practice (N=4, 100%). Conclusion: The implementation of this quality improvement protocol was an effective approach to increasing stroke risk awareness, stroke risk screening, addressing implementation barriers, and knowledge gaps. Providers behavior change in response to the stroke risk protocol supports research that a systematic stroke risk screening process is most beneficial for consistency of screenings amongst primary care providers. Replication of this quality improvement project, and addressing its limitations, is needed to determine similar results in larger settings. |
