For every minute without treatment for a stroke, 1.9 million brain cells die. For every hour without treatment, the brain loses almost the same number of cells as are lost through 3.6 years of aging. When it comes to a stroke, time is brain.
A stroke occurs when a clot or broken blood vessel cuts off vital blood flow and oxygen to the brain. Strokes cause brain damage and abilities such as speech and movement, and memory can be lost. Last year, Mount Nittany Medical Center cared for more than 450 patients that suffered a stroke.
The Medical Center’s stroke program is dedicated to optimizing the quality of life through coordinated, evidence-based best practice for stroke risk reduction and stroke interventions. The Medical Center is an accredited Primary Stroke Center through The Joint Commission and recently earned the American Heart Association & American Stroke Association 2020 Get with the Guidelines® Stroke Gold Plus Achievement Award with Target: Stroke SM Honor Roll Elite and new for this year, Target: Stroke Type 2 Diabetes Honor Roll.
“Providing evidence-based, scientific-guided care means our community can have faith in us. We are providing great care and following national guidelines,” shares Susan Maynard, MS, RN-BC, CCNS-CMC, CCRN-K, stroke coordinator, Mount Nittany Medical Center.
The Joint Commission, an independent organization that accredits and certifies healthcare organizations across the country, says the accreditation is, “a signal to your community the quality of care you provide meets the unique and specialized needs of stroke patients.”
For stroke patients transported via ambulance, the stroke care team is completely ready for them when they arrive. Emergency medical services (EMS) conducts pre-hospital assessments that are specific to stroke and calls ahead to the emergency department (ED).
The physician in the ED then calls a stroke alert, mobilizing people and processes to care for the incoming patient. If indicated, clinical staff set up the TeleStroke cart—a partnership with Milton S. Hershey Medical Center —to provide remote neurological consults to aid diagnosis and treatment in a patient’s home hospital. They also look up available information in the patient’s chart to incorporate any pertinent medical history.
The team meets the patient to conduct a brief assessment before taking them for a CT scan, readied with the stroke alert to help the patient receive care fast. After the scan, the patient is cared for in the ED, including potentially receiving the clot busting drug alteplase.
Because speed is so important, each of the major steps has a strict national standard time goal. The door to CT scan goal is 20 minutes, door to CT scan read 45 minutes, and door to alteplase 60 minutes.
“I’m incredibly proud of how fast we give alteplase,” shares Maynard. “Back in 2012 our average time was 120 minutes. In 2019, our average time was 55 minutes, and that’s with a significant increase in the number of doses. This is a huge testament to EMS, to the ED team, and to all the departments that are involved. Every time we give alteplase faster, we’re saving years of disability.”
The stroke program brings together representatives across disciplines who play a role in stroke care, including neurology, the ED, medical and progressive care units, rehab, radiology, case management, pharmacy, and hospitalists.
A relatively new initiative in stroke care is having stroke nurse champions at the Medical Center in critical care, the ED, and the medical unit. These champions attend monthly committee meetings, bringing valuable feedback from the front line and disseminating information back to their colleagues.