|
A recent article in the
New York Times by Richard Perez-Pena (July 27, 2003)
confirms what the Chattanooga Network for Stroke has
been working toward to improve stroke care in our region.
As you are all know the FDA approved IV t-PA within
a three hour for acute ischemic stroke in 1996 and the
NIH has declared this thrombolytic to be the gold standard
for acute stroke treatment. Why today, almost eight
years later, are many patients still not receiving this
therapy? There may be a number of reasons, but this
article suggests the probem lies within the hospital
itself.
At your hospital, even if you do not administer t-PA,
designate a person as the “Stroke Champion”
for your hospital. Have this person gather a small committee
together to look at the “Stroke Chain of Survival”
to see where you can improve your treatment or transfer
times for your hospital. Suggestions for committee members
would include ER physician, Triage RN, Neurology, Radiology,
EMS, American Heart Association Liaison, Quality Assurance
personnel, pharmacy, Marketing/Public Relations etc.
The Stroke Chain of Survival includes:
- Detection of the onset of stroke signs and symptoms
- Dispatch through activation of the EMS system
- Delivery of the victim to the reciving hospital while
providing appropriate prehospital assessment and care
and prearrival notification.
- Door (emergency department triage)
- Data (Emergency department evaluation, including computed
tomography
- Decision about potential therapies
- Drug therapy
Your hospital can work to improve the links in this
“chain” through healthfairs, posters in the
hospital, billboards, television, radio and newspaper
ads and articles (many of these are considered public
service ads and may be free). This is a great way to
promote your hospital and educate the public on the
signs and symptoms of stroke and the need to activate
911. EMS dispatch play a critical role in the timely
treatment of potential stroke victims and prehospital
transport and management of the patient.
The Chattanooga Network for Stroke can play an important
role in assisting with the training of your EMS in detection
and management of stroke. Please contact us at info@cnshelp.com
to arrange for classes. Once the patient reaches your
emergency department door, the patient must be seen
immediately and a decision to treat or transfer must
be made. Again, even if your facility does not administer
tpa, you could benefit from a written plan as how to
fast track those patients through your system. This
could include working with EMS for prehospital notification,
a code on the beeper to indicate a stroke patient is
incoming (to alert CT etc), and targets for goals to
expedite treatment or transfer. The NINDS has recommendations
for targets for evaluation of potential candidates for
thrombolytic therapy. Written orders and protocols are
important for standard of care.
For more information on the NY Times article visit their
website, NYTimes.com
The American Stroke Association has a program to assist
you in strengthening your stroke program. You can purchase
this on their website www.strokeassociation.org
or call your local American Heart Association.
|
