Session Information
Date: Saturday, November 16, 2019
Session Title: Quality Improvement Case and Research Report
Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 8
Disclosures: Daniela A. Iliescu, MD: Nothing to disclose
Objective: Prevalence of Post-Stroke Depression (PSD) is as high as 35% and is associated with multiple adverse outcomes including decreased functional recovery during acute rehabilitation and increased mortality. Early PSD screening is Class I recommendation based on AHA/ American Stroke Association 2018 guidelines. Baseline interrogation revealed no PSD screening in our hospital, preventing treatment prior to the post acute care setting and potentially limiting recovery. Our aim was to achieve 30% compliance with PSD screening in 4 months using PHQ-9.
Design: Single center prospective quality improvement study.
Setting: Multidisciplinary neurology service team of a Stroke Center.
Participants: Patients over age of 18 admitted with imaging evidence of stroke with exclusion of patients with TIA, coma, anosognosia, aphasia, or cognitive impairment.
Interventions: Over a 4-month period, four serial PDSA cycles tested the changes predicted to achieve our aim. Interventions included the following in cumulative manner; 1. Availability of printed PHQ-9 tools. 2. Algorithm for the workflow with preassigned tasks and adding a smart phrase into EMR. 3. Immersion of dedicated members into the process and pitfall identification. 4. Education and inclusion all members of the care team, developing an advanced documentation template into EMR and using mobile apps for ease.
Main Outcome Measures: The percentage of patients meeting inclusion criteria screened for PSD on neurology service.
Results: Among 53 patients screened, the compliance increased over the four PSDA cycles with 1%, 25%, 50% and 53% respectively and overall compliance of 33%. Qualitative data collected guided the intervention in the subsequent cycles. Barriers included lack of dedication and awareness, and workload.
Conclusions: Implementing PSD screening in the acute phase of care workflow using a multidisciplinary approach as outlined above can be an effective tool to improve compliance with evidence-based intervention. Additional cycles are planned to implement the protocol into EMR for consistency in all five full-service hospitals and rehabilitation centers in network.
Level of Evidence: Level I
To cite this abstract in AMA style:
Iliescu DA, Essa A, Prasanna T, Sandin KJ, Villanueva E, Butler M, Valiquette A, Andukuri V. Model for Implementation of Post-stroke Depression Screening in the Acute Phase of Care [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/model-for-implementation-of-post-stroke-depression-screening-in-the-acute-phase-of-care/. Accessed May 15, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/model-for-implementation-of-post-stroke-depression-screening-in-the-acute-phase-of-care/