Health & Wellness: Race Against the Clock
If there is one word that medical experts want to impress upon the general public during national Stroke Awareness Month it’s “fast.” Not only does it serve as a reminder to act quickly when faced with the possible onset of a stroke, but also as a helpful acronym for what symptoms to look for and what to do when you see them: Face drooping, Arm weakness, Speech difficulty, and Time to call 911.
According to the American Stroke Association, about 795,000 Americans each year suffer new or recurrent strokes, and it is the fourth-leading cause of death nationally. Typically viewed as a disease affecting the elderly, recent studies show an increase of strokes among young adults under the age of 55. While this may be attributed to heightened awareness of the disease and its symptoms, studies also show that high cholesterol, obesity, and smoking were common in young adult stroke patients.
Stroke is a disease that affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so that part of the brain and its cells die. And the more time that passes following a blockage, the more severe the impact to the brain and its ability to function. As most doctors will tell you, “time is brain.”
Efficiency in dealing with the aftermath of a stroke could mean the difference between a full recovery or living with debilitating neural and physical impairments for life. This is what has motivated doctors and nurses within neurology and the emergency department at Mount Nittany Medical Center to seek areas for improvement in the level of care given to stroke patients. For the past year and a half, the team has been involved in a voluntary certification process through the Joint Commission to become Primary Stroke Center certified. Offering both primary- and comprehensive-level certification, the Joint Commission is the national governing body that accredits and certifies more than 20,000 health-care organizations and programs in the United States.
Each level of certification, both primary and comprehensive, comes with a certain set of criteria and guidelines. General standards for disease-specific certification as determined by the Joint Commission include program management, clinical-information management, delivering or facilitating care, supporting self-management, and measuring and improving performance. More specifically, Primary Stroke Center Certification includes such indicators as the time it takes for Emergency Medical Services to get a patient to the hospital after the onset of symptoms, and emergency-department protocols involved in the evaluation and treatment of a patient.
Pete Roy, MD, neurologist, Mount Nittany Physician Group, has been heavily involved in the certification process and describes it as an “all-hands-on-deck” approach.
“It has taken a lot of hard work among all members of our staff, including nurses, doctors, emergency department, radiology, administration, EMS — all these people are working together to help create the parameters that allow us to achieve primary certification,” he says. “Stroke certification is part of our mission, and that mission is that we exist to provide better health. It’s all part of the overall picture of caring for the community.”
Part of the Primary Stroke Center Certification is the implementation of the TeleStroke Program. Roy and Jennifer Vance, a registered nurse and stroke coordinator at Mount Nittany Medical Center, are part of the team working with the technology, which also includes physicians and nurses at the Penn State Milton S. Hershey Medical Center.
Housed in the emergency department, the TeleStroke machine is an Internet-based system that is used for emergent neurology consultations. Primarily, it is used by nurses in the emergency department for stroke-patient consults. Equipped with a monitor, it allows doctors at Mount Nittany Medical Center to evaluate patients face-to-face with physicians at Penn State Hershey Medical Center.
“TeleStroke is a nurse-driven technology, in that if our nursing staff sees a patient that they feel may be having a stroke, they can grab the cart and get it ready for a consult,” says Vance. “When our physicians wish to proceed with a TeleStroke consult, our staff makes a phone call to Hershey and we can have a neurologist on the screen within eight to 10 minutes.”
Physicians at Penn State Hershey Medical Center carry headsets and laptops equipped with 4G wireless cards that allows them to access the Internet wherever they may be. As soon as a nurse at Mount Nittany Medical Center prepares for a consultation, even if an official evaluation doesn’t take place, Penn State Hershey Medical Center physicians are notified through their pagers that the TeleStroke machine is in use. This alerts them to be ready if, based upon the doctor’s assessment, further evaluation or procedures are required.
“Doctors on-call can be out seeing patients, or out living their lives, and they will get the heads-up that the TeleStroke machine is in use by nurses or doctors at Mount Nittany,” Vance describes.
The timeliness and ease-of-access associated with the machine only helps to further enhance the level of care given to stroke patients. The less time required in evaluating and treating the patient, the better the outcome.
“The TeleStroke Program is a catalyst for showing the full range of care we are able to give our patients,” says Roy. “Patients can get a consult, while benefitting from the expertise of physicians here and experts at Hershey. It’s a nice tool to evaluate and treat patients. Through TeleStroke, the ER doctor has instant access to a neurosurgeon who deals frequently with stroke, and they can develop a more efficient plan of action.”
Mount Nittany Medical Center also benefits from a close relationship with HealthSouth Nittany Valley Rehabilitation Center in Pleasant Gap. Earning Disease-Specific Care Certification from the Joint Commission, in addition to Joint Commission accreditation, HealthSouth works with Mount Nittany Medical Center to ensure all stroke patients are evaluated by a physical or occupational therapist and set up for treatment or ongoing care. As an inpatient rehabilitation hospital, HealthSouth is able to offer patients in the area an acute level of care not typically found in other facilities offering rehabilitation services, such as nursing homes or assisted-living centers.
“Collaborative relationships like these are important to ensuring safe transitions of care for our patients,” says Richard Allatt, MD, FRCPC, medical director, HealthSouth Nittany Valley Rehabilitation Hospital. “Stroke rehabilitation is essential to supporting improved patient outcomes and reducing the burden of care for our community.”
Marianne Hazel of Bellefonte experienced HealthSouth’s care firsthand after her father, Joseph Hazel, suffered a stroke. With her father also being an Alzheimer’s patient, it was important for Hazel that her father’s treatment be consistent and routine. She says it also helped that HealthSouth was able to offer a personal level of care.
“Following his stroke, Dad experienced speech difficulties, lost a great deal of cognitive abilities, was unable to perform daily living activities, and was extremely weak, needing a wheelchair,” she recalls.
Following his hospital stay, Hazel’s father was moved to HealthSouth, where rehabilitation experts worked with him to help him regain his strength. Through physical therapy, he was able to walk short distances using a walker. With occupational therapy, he resumed some small muscle control and gained back some of his cognitive ability.
“HealthSouth provided just the right balance, with a sense of humor, encouraging him and pushing him to begin his therapy,” Marianne Hazel says. “It touched my heart to watch them work with my dad and to treat him just like he was their dad.”
In addition to the consistency of care, HealthSouth , which has a Stroke Support Group that meets at 4 p.m. the last Tuesday of each month, also worked with Hazel following her father’s treatment to help prepare her to be his full-time caregiver.
“I received valuable resources and utilized HealthSouth’s informational sessions,” she says. “I truly believe that HealthSouth’s rehabilitation was the foundation for my dad’s continual improvement. We have such gratitude for the staff, as they have made such a difference in our lives.”
While timeliness in the delivery of treatment by a medical expert is crucial in stroke-patient care, much of the initial responsibility rests upon the patient’s ability to identify and quickly react to symptoms. As part of their ongoing effort to educate the community, and in honor of Stroke Awareness Month, Mount Nittany Medical and HealthSouth will offer a special presentation on May 21 featuring Dr. Roy titled “Time Loss = Brain Loss: How to Recognize and Act on Signs of a Stroke Quickly.” The goal of the event is to raise awareness of the disease and to instill in the community the importance of being able to identify symptoms and react quickly.
“Community health education is part of our mission at HealthSouth,” says Susan Hartman, CEO, HealthSouth Nittany Valley Rehabilitation Hospital. “Not only do we partner with Mount Nittany Health on the treatment of patients following a stroke, it is critical that we work together to increase awareness of stroke prevention. This event gives us a unique opportunity to partner with Dr. Roy to demonstrate that commitment and to share new treatment options and technologies available to stroke survivors.”
Not only do programs like this help full-time stroke-patient caregivers such as Marianne Hazel, who plans to attend the workshop, but also those who are unfamiliar with the disease.
“We can’t help people if they have problems and don’t tell anyone,” Roy says. “We rely on people to call 911 and seek help.”
For more information on “Time Loss = Brain Loss: How to Recognize and Act on Signs of a Stroke Quickly,” visit www.mountnittany.org/events. The event is 6 p.m. May 21 in Mount Nittany Medical Center’s Galen and Nancy Dreibelbis Auditorium.
For more information on HealthSouth’s Stroke Support Group, call Caroline Salva-Romera at (814) 359-3421.