Within an hour of arriving at Baptist Hospital East, appropriate patients with ischemic stroke (which is usually caused by a blood clot) are able to receive intravenous tissue plasminogen activator (t-PA), a clot-busting drug which dissolves the clot and reduces the chance of permanent disability.
Patients can receive this drug only if three hours or less has elapsed between the time they were last seen to be normal, or without symptoms, and the time t-PA is administered.
This quick diagnosis and decision to treat meets the benchmark for The Joint Commission standards for Stroke Center certification - an unusually high standard for a community hospital without in-house neurologists available 24 hours a day.
If a patient comes in with an acute stroke, a stroke neurologist calls a ‘Team D' which is similar to what is done for a heart attack patient. Everyone springs into action when the patient arrives in the Emergency Department. The patient is rushed to CT in a very well-defined process. The next step is to make sure EMS knows to call the team, so they can be waiting for the patient.
When the Team D is activated, the beeper dedicated to the team is paged. The page goes directly to the stroke neurologist who is on-call, bypassing an answering service and saving precious time.
To rule out a stroke caused by bleeding, a CT scan is performed. Other causes of symptoms must also be ruled out, such as low blood sugar. A strict inclusion/exclusion criteria is evaluated and a stroke scale score is also determined to gauge if the patient is a good candidate for t-PA. One major factor is whether the patient’s symptoms began within the last three hours.
As with major trauma or heart attack, time is of the essence with stroke victims. The faster a patient is treated, the better they do. For patients who receive stroke treatment within one hour of noticing symptoms, their chances of recovery are quadrupled. If they get the proper medical help within two hours of having symptoms, their chances of a full recovery are doubled. Chances of recovery increase only 10 to 20 percent for patients receiving treatment in three hours of noticing symptoms. Every minute makes a difference.
Baptist East has consistently been treating patients within an hour of their arrival at the hospital. Since the team began its work in February 2004, about 5 percent of patients have been treated with IV t-PA. Nationally, only 3 percent of stroke patients receive IV t-PA.
One issue is that people often don’t call 911 right away because they fail to recognize the warning signs of stroke.
This emphasis on speedy initial care fits in nicely with Baptist East’s already existing services for stroke patients, including interventional neuroradiologists, a neurosciences nursing unit, rehabilitation unit with stroke education for patients and their families and a Stroke Club to support those who’ve returned home.
A multidisciplinary team comprised of physicians and other clinical staff from ED, Radiology, and Neurology devised the Team process. ED and Radiology physicians and staff have excelled in trimming response time to enable more patients to be eligible for t-PA with the three-hour treatment window.
Stroke symptoms
Stroke is the third leading cause of death in the United States, behind heart disease and cancer.
· Sudden numbness or weakness of face, arm or leg, especially on one side of the body.
· Sudden confusion, trouble speaking or understanding.
· Sudden trouble seeing in one or both eyes.
· Sudden trouble walking, "dizziness," loss of balance or coordination.
· Sudden severe headache with no known cause.
If you see or have any of these symptoms, call 911 immediately.
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