On average, someone has a stroke every 40 seconds. The gaps for patients diagnosed with a stroke are the availability

of physicians who specialize in stroke care and access to evidence-based stroke care. Telemedicine has assisted in bridging this gap to provide effective stroke treatment. The purpose of this article is to describe how the implementation selleck kinase inhibitor of a hub and spoke model using telemedicine has assisted in increasing patient access to neurology expertise and receiving evidence-based treatment of recombinant tissue plasminogen activator, thereby improving patient outcomes. Cindy Murray, Elizabeth Ortiz, and Cay Kubin The purpose of this article is to present an option for a model of care that allows small rural hospitals to be able to provide specialty physicians for critical care patient needs in lieu of on-site critical care physician coverage. A real-time, 2-way audio and video remote presence robot is used to bring a specialist to the bedside to interact with patients. This article discusses improvements in quality and finance outcomes as well as care team and patient satisfaction associated with this model. Discussion also includes expansion of the care model to the emergency department for acute stroke care. Kristine K. Powell and Rita J. Fowler This article describes the Baylor Health Care System (BHCS) approach to decreasing sepsis-related mortality within a large complex adaptive health care selleck system. BHCS implemented

sepsis care improvement initiatives based on the Surviving Sepsis Campaign early goal directed therapy guidelines. By adhering to rigorous process improvement and evidence-based practice principles, BHCS has demonstrated improvements in sepsis care processes and a significant reduction in sepsis mortality. Amy Veenstra and Emylene Untalan Surgical patients with known or unknown obstructive sleep apnea are at increased risk for postoperative complications. By implementing evidence-based practices and a validated screening tool, the postoperative surgical patients at the authors’ hospital have Megestrol Acetate a decreased risk of postoperative complications, specifically oversedation.

This article discusses the pathophysiology, prevalence, risk factors, care of the postsurgical patient, and use of the validated STOP-Bang questionnaire with obstructive sleep apnea as the focus. Ryan Beseda, Susan Smith, and Amy Veenstra Providing evidence-based care to patients with return of spontaneous circulation after a cardiac arrest is a recent complex innovation. Once resuscitated patients must be assessed for appropriateness for therapeutic hypothermia, be cooled in a timely manner, maintained while hypothermic, rewarmed within a specified time frame, and then assessed for whether hypothermia was successful for the patient through neuroprognostication. Nurses caring for therapeutic hypothermia patients must be knowledgeable and prepared to provide care to the patient and family.