Development and Implementation of an Evidence-based Cryptogenic Ischemic Stroke Clinical Decision Support Pathway at Wellstar Health System: A Quality Improvement Initiative
Objective:
This initiative aimed to reduce variations in care, enhance patient safety, and improve practice efficiency and effectiveness in managing cryptogenic ischemic strokes.
Background:
Up to one-third of ischemic strokes are cryptogenic, with Georgia located in the high-risk “Stroke Belt.” Within Wellstar Health System, diagnostic and follow-up variability among multidisciplinary providers can lead to inefficiency, increased costs, and delays in care. Standardizing care aligns with organizational goals of optimizing outcomes, reducing variability, and improving clinician well-being. The project’s purpose was to create a standardized pathway to ensure equitable, evidence-based, and efficient management of cryptogenic stroke.
Design/Methods:
A mixed-methods approach evaluated a Cryptogenic Stroke Clinical Decision Support System (CDSS) designed through literature review and multidisciplinary consensus (neurology, cardiology, radiology, hematology, rheumatology, clinical informatics, and clinician well-being). Pre- and post-intervention assessments of internal medicine residents (n=21 pre, n=18 post) and attendings (n=4 pre, n=3 post) measured confidence, familiarity, and workflow adherence. Qualitative surveys evaluated CDSS usability and perceived value.
Results:
Implementation improved clinician knowledge, confidence, and diagnostic consistency. Residents showed greater comfort managing ischemic stroke patients, stronger grasp of systematic diagnostic approaches, and improved application of risk stratification tools. Residents showed improved knowledge in determining next diagnostic steps after routine testing. Familiarity with objective stroke risk stratification tools also increased post-intervention. Attending physicians also demonstrated enhanced confidence and familiarity with evidence-based workflows. Qualitative feedback emphasized reduced uncertainty and improved standardization.
Conclusions:
The CDSS improved clinician confidence, adherence to systematic workflows, and consistency in cryptogenic stroke care. It demonstrated potential to reduce variability, optimize resource use, and enhance outcomes. This initiative established proof of concept for broader integration into Wellstar’s electronic medical record, advancing system-wide standardization and supporting Wellstar’s vision of delivering world-class, equitable care to every patient.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.