It Takes A Village: And Other Lessons Learned From A Large Volume Comprehensive Stroke Center

Introduction: The Joint Commission (TJC) certification as a Comprehensive Stroke Center (CSC) entails coordination across multiple units of clinical / academic institutions, and the demands on resources are daunting. Certification standards lack resource allocation recommendations. We present data on workload quantum and resource requirements based on experiences from a TJC certified, high-volume CSC. Methods: We conducted a desk audit of frequency-based CSC staff activities. An outside team member conducted interviews, followed by collective adjudication for precise categorization. Redundant and overlapping tasks were removed iteratively, and activities were cross-linked with other sources (meeting minutes, individual calendars, on-call schedules). Person-time per task is a product of number of hours and team members. Person-Hours/Day (PHD) were determined by factoring task frequency. PHDs were used to calculate Full Time Employee (FTE) requirements. Volumes were obtained from our CSC registries. Results: Our CSC received 2,840 patients between 4/1/2016 and 3/31/2017. Among ischemic stroke patients, 30.5% received IV tPA and 119 underwent intra-arterial thrombectomy. Overall, 60 independent activities were divided into 7 mutually exclusive categories (Table 1). Daily, weekly, and monthly activities collectively constituted 83.3% of all the activities. A total of 67.43 PHDs were computed of which data processes are the most resource consumptive (32.07 PHD) followed by core measures tracking (13.8 PHD) (Figure 1). Collectively, the top two activities account for 68% of all PHD and approximate a requirement of six FTEs. Details of activities will be presented. Conclusion: Adequate planning and continual assessment of resources is imperative to optimal CSC operations and patients’ quality of care. Resources are significantly volume driven. Integrative nature of data processes are central to CSC functioning and necessitate resource evaluation.