Date of Graduation

Summer 8-12-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

David Ainsworth


Problem: The 90-day mRS post discharge call project aimed to improve the outreach in stroke patients treated with thrombolytics alone or in combination with mechanical endovascular reperfusion (MER) therapy. An audit of calls was completed and revealed a gap that a number of patients were not reached or did not receive a call attempt. Having a higher outreach provides useful feedback on the patient’s progress within 90-days of being discharged in relation to the effectiveness of the stroke treatment received according to the mRS.

Context: The Neuro Coordinator was responsible for making the 90-day post discharge call and worked in collaboration with the Stroke Coordinator who tracked the patients eligible for the call. The completion rate of the 90-day mRS post discharge call is monitored by the Multidisciplinary Stroke Oversight Committee. The biggest challenge was reaching the patient.

Interventions: This project implemented interventions to improve outreach by ensuring correct patient contact information in place, educating patients on the purpose of the call and the expectations by way of a face-to-face meeting, and enhancing the existing workflow by standardizing processes including the scheduling of the call.

Measures: Measures for this project captured the number of patients who received a face-to-face meeting and a scheduled appointment for the call prior to discharge. The outcome measure for this project was the percent of patients with a completed call within 90-days of their discharge.

Results: A 10% improvement in the outreach was achieved with 87% of the patients receiving a face-to-face meeting with the Neuro Coordinator before discharge.

Conclusions: Improving the patient’s knowledge of the 90-day mRS post discharge call by instilling new processes that enhanced the existing workflow and standardized the practice for the Neuro Coordinator and Stroke Coordinator to improve patient outreach.