Date of Award


Document Type


Degree Name

Master of Science (MS)

Legacy Department



Howe, Linda

Committee Member

Eggert , Julie

Committee Member

Dawn , Blackhurst

Committee Member

Cynthia , Trout


The purpose of this study was to determine whether the implementation of a stroke clinical pathway could improve compliance with documentation of specific quality measures for patients admitted with the diagnosis of acute ischemic stroke, hemorrhagic stroke, or transient ischemic attack. The study used the ten standardized performance measures for stroke identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and integrated documentation of those measures into a stroke clinical pathway consisting of physician order sets, an interdisciplinary plan of care, and a patient/family education flow sheet. The American Stroke Association's Get with the Guidelines - Stroke (GWTG-Stroke) database was used to collect data retrospectively on 220 patient records. The control group consisted of 110 randomly selected records of patients admitted with stroke in the year prior to clinical pathway implementation. The intervention group consisted of 110 consecutive records for patients discharged with a stroke diagnosis six months after clinical pathway implementation. Six data collectors reviewed the records to gather the information. Records were entered into the database by a single researcher. A pre-defined measure report was prepared for the 'JCAHO Pilot-10' from the GWTG-Stroke database. Comparison of the control and intervention groups using the Fisher's Exact test and 95% confidence intervals revealed statistically significantly higher rates of compliance with the patient/family stroke education (p<0.001) and smoking cessation counseling (p<0.001) measures after pathway implementation. Further analysis of the intervention group was done to determine if the use of the clinical pathway forms increased documentation compliance with the measures. There was a statistically significant improvement in documentation of the measures for the lipid profile (p=0.003) and patient/family stroke education (p<0.001) measures when at least one form in the clinical pathway was used. A Chi-square test for linear trend indicated there was a statistically significant increase in the number of measures met as the usage of the clinical pathway increased (p<0.001). This study suggests that implementation of a stroke clinical pathway can improve compliance with documentation of specific performance measures by members of the healthcare team.

Included in

Nursing Commons