Crozer-Keystone Stroke Protocol Presented at National Industry Conference
SPRINGFIELD, Pa.-- An interdisciplinary team of professionals from Crozer-Keystone Health System has developed and implemented a new emergency stroke protocol that is helping doctors obtain critical test results in a fraction of national benchmark times. For stroke patients, getting timely treatment can significantly impact their chances of surviving and having a successful recovery.
The initiative began at Delaware County Memorial Hospital (DCMH) in Drexel Hill and has since been rolled out at Crozer-Chester Medical Center and Taylor Hospital. All three Crozer-Keystone hospitals are Joint Commission-certified Primary Stroke Centers, which means that they meet the highest national standards of care for stroke patients.
“We were already doing well, but we wanted to do even better,” says Crozer-Keystone EMS Assistant Chief Scott Dunbar, who was instrumental in developing the stroke care initiative.
Representatives from DCMH were invited to present a poster outlining their enhanced emergency stroke protocol at the International Stroke Conference presented by the American Heart Association and the American Stroke Association in San Diego this past February.
“We came together as a group to make this work,” notes Terri Hoffecker, M.S.N., R.N., nurse director of the DCMH Emergency Department, who attended the international stroke conference with Dunbar and DCMH paramedic Avery Schwenk. Hospital departments that were instrumental in the stroke collaboration include Radiology, Neurology, Patient Access, Pharmacy, the Emergency Department and EMS.
How Crozer-Keystone is Beating the Clock
A stroke happens when blood flow and oxygen to the brain are restricted. This can be caused by a clot or blockage in the vessels that stops blood flow, which is most commonly the case. Or it can be caused by a rupture or hemorrhage.
Before stroke patients can be treated, they must first have a CT scan to determine the cause. If a clot is found, then clot-dissolving medication may be administered. But treatment is much different in the case of a hemorrhage, which is why testing is critical.
Streamlining the emergency protocol so that patients can get their CT results and the appropriate care more quickly was the focus of the stroke care initiative. At all three Crozer-Keystone hospitals, changes have been made to the emergency procedures so that an expedited pathway to testing can begin as soon as paramedics arrive in a potential stroke patient’s home.
For patients who meet designated criteria, EMS calls the hospital from the field to initiate a stroke alert, and medics begin necessary preparations, including starting an IV and drawing blood on the way to the hospital.
When the patient arrives at the ED, a team of providers is ready and waiting to complete a rapid assessment and the patient is transported directly to CT for testing while still on the EMS stretcher.
Far Outperforming the National Benchmark
Improvements in care delivery times have been seen at all three Crozer-Keystone hospitals and were reflected on the poster that DCMH presented at the stroke conference in February.
Since the changes were implemented to the emergency procedures, the time from patients’ arrival at DCMH to when they get their test results (known as “door-to-CT result time”) went from 32 minutes to 16 minutes. That’s well below the national industry benchmark of 45 minutes, Hoffecker notes.
Crozer and Taylor have seen similarly positive results, supporting faster delivery of emergency treatment, which is critical to achieving the best outcomes.
Know the Signs
Both Dunbar and Hoffecker emphasize how important it is for people to know the stroke warning signs and call 9-1-1 immediately if these symptoms arise.
The National Stroke Association urges people to remember the word “FAST” to identify these warning signs of stroke:
- FACE: Ask the person to smile. Does one side of the face droop?
- ARMS: Ask the person to raise both arms. Does one arm drift downward?
- SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
- TIME: If you observe any of these signs, call 9-1-1 immediately.
Stroke is the number-four cause of death and the leading cause of adult disability in the United States, according to the American Heart Association/American Stroke Association. Chances of successful treatment and recovery are much better if people heed the warning signs and receive timely emergency care.
Crozer-Chester Medical Center, Delaware County Memorial Hospital and Taylor Hospital have been certified by The Joint Commission as Primary Stroke Centers. This means that the hospitals’ programs meet the highest national standards of care for stroke patients and adhere to guidelines that can significantly improve outcomes for stroke patients. To find out more about Crozer-Keystone’s stroke services, visit http:\\stroke.crozerkeystone.org.