Cardiac Diagnostics and Monitoring
Stroke pathway planning guide
Multidisciplinary collaboration for long-term cardiac monitoring
What is a stroke pathway?
A stroke pathway, or stroke protocol, is a consistent approach to a follow-up plan and transition of care for patients with an ischemic stroke. This implementation guide is intended to extend your acute stroke protocol to include a cardiac monitoring plan for cryptogenic, large-vessel, and small-vessel stroke patients. It includes monitoring for atrial fibrillation (AF) with the best monitoring mechanisms available to optimize outcomes.
After initial stroke discharge, many patients do not receive any additional cardiac monitoring. Establishing a monitoring pathway to detect and treat AF can significantly reduce a patient’s risk for another stroke.1 The ability to identify AF in patients with ischemic stroke has profound implications for long-term medical management.
Multi-disciplinary collaboration
Watch clinicians discuss best practices regarding establishing a stroke pathway.
Ensure a standard of care.
Many ischemic stroke patients are lost to follow-up. Pathways for transition of care and follow-up help to ensure these patients receive better care.
A stroke pathway allows all healthcare professionals involved in the continuum to ensure a standard of care. Through this pathway, hospitals can:
- Provide underserved patient population a better risk reduction strategy to prevent a secondary stroke.
- Establish cross-functional healthcare professional relationships to ensure integrated care delivery.
- Ensure multidisciplinary stroke care involving both neurological and cardiovascular care.
- Enhance hospital reputation in providing exemplary stroke care.
Medtronic can assist your team in the planning and implementation of your stroke pathway. Request to be contacted by a local sales representative.
Pathway planning steps
1. Involve all stakeholders.
When developing the stroke pathway, it is important to include all stakeholders who care for the stroke patient, including:
- Neurology
- Cardiology
- Electrophysiology
- Administration
- Stroke coordinators/stroke navigators
- Nurses
- Rehab physicians
- Interventional cardiologists
- Hospitalists/interventional neurologists
Identifying a pathway champion to drive the initiative is critical to ensuring successful implementation.
2. Develop and implement the pathway.
It is ideal to have both neurology and cardiology champions and to bring together all stakeholders as a multidisciplinary team to discuss key aspects of the pathway, including:
- Patient selection criteria for insertable cardiac monitoring (ICM).
- Patient pathway for ICM, including transition of care and follow-up plan.
- Process improvement data and tracking.
- Ongoing communication among all specialties involved in the stroke care of the patient.
- Ongoing education plan for all stakeholders.
It is essential to establish patient ownership, coordination of care, and a transition of care plan. The cardiac monitoring plan must be very clear at the onset and consistent throughout the continuum.
3. Ongoing education of all stakeholders
Education and communication is crucial to pathway implementation and ongoing success. Be sure to establish a plan and ownership for key pathway education and communication in your hospital.
Education for the healthcare professional team
- Educate the entire care team on the cryptogenic stroke pathway (including hospitalists, nurses, Fellows, and PCPs).
- Integrate communication touchpoints into the pathway; communication is important prior to insertion, after insertion, when AF doesn’t/does occur, and prior to OAC initiation (if deemed necessary).
- Consider integrating the pathway/protocol into your EMR.
- Hold monthly interdisciplinary “workflow” assessment meetings involving inpatient and outpatient care to ensure standardization of the process.
- Use in-services and existing educational vehicles at the hospital for continued education.
Education for patients/caregivers
- Inform the patient/caregivers about the cardiac monitoring plan and why it is important to look for AF with ICM after a cryptogenic stroke.
- Designate nurse responsible for patient education throughout the care continuum (bedside nurse, nurse educator, nurse navigator, etc.).
Partner with Medtronic
Medtronic can help identify resources available to assist your team in pathway planning and implementation, as well as provide education on utilizing Medtronic ICMs for stroke.
These pathways are provided for educational purposes and should not be considered the exclusive source for this type of information. It is the responsibility of the practitioner to exercise independent clinical judgment.
Collaboration in action for cryptogenic stroke
Neurology and cardiology work collaboratively to improve the diagnosis and treatment of cryptogenic stroke patients.
Medtronic Disclosure Statement: This pathway is provided for educational purposes and should not be considered the exclusive source for this type of information. It is the responsibility of the practitioner to exercise independent clinical judgment.
Refer to the brief statement for indications, warnings/precautions, and complications for the Reveal LINQ™ ICM.
Reference
1
Tsvigoulis G, Katsanos AH, Mac Grory B, et al. Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia. Stroke. August 2019;50(8):2175–2180.