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Coordinated stroke care saves lives

By The Health News Team | May 18, 2021
Medical equipment on the background of a group of health care workers.

It is commonly known that every minute counts when someone is having a stroke. Experts often share the “BE FAST” method to help people remember how to recognize the signs of stroke and what to do to help save a life. And reminders that “time is brain” are at the forefront of stroke education.

Such widely shared knowledge, paired with public awareness campaigns addressing ways to prevent stroke, have led to a decrease in severe illness and death caused by stroke. However, this doesn’t mean that the stroke care teams at Sharp HealthCare hospitals will ever stop reviewing and improving their stroke care processes.

“Our stroke protocols and processes have evolved and continue to evolve,” says Dr. Julie Phillips, medical director of the emergency department at Sharp Grossmont Hospital. “Five years ago, we were doing it one way, and then we found a better way. We never stop trying to get better. That’s how medicine works. It’s never, ‘Oh great, this works. Let’s just leave it this way.’ We’re always asking, ‘Can we do better?’”

When mere minutes can save a life

According to Dr. Phillips, she and her colleagues have stroke code meetings every month to review protocols and practices. They spend hours of review to make even a 1-minute difference in the emergent care of stroke patients.

“Because we see so many patients at Sharp Grossmont, we can see improvements in action,” Dr. Phillips says. “We get very fast feedback for all process improvements, and it makes us strive to continue to do more. You make one step of improvement and then you figure out that maybe you can take another, and then another.”

Such diligence and dedication to the highest quality of care is evident across Sharp, which means that all stroke patients seen at any Sharp hospital in San Diego County will receive the same exceptional treatment within the first hour of arriving on-site. From the moment a person reaches a hospital’s ER, or a hospital is notified by paramedics that a potential stroke patient is on their way to the ER, Sharp’s exclusive best practices protocol begins.

“If a patient is coming in by ambulance and showing signs of stroke, the EMTs or paramedics will alert the radio room nurse that they might have a stroke patient,” Dr. Phillips explains. “We will activate a stroke code alert throughout the hospital and assemble a team that includes a stroke nurse, an ER physician, the charge nurse and the bedside nurse in the receiving area. We all wait for the patient to arrive, so that as soon as they come out of the ambulance, we can get a report from the paramedics and do our own assessment on the spot.”

From there, the team takes the patient for CT scans to determine if they are experiencing a stroke, and whether the stroke is due to a blocked blood vessel, called an ischemic stroke, or a rupture in a blood vessel within the brain, known as a hemorrhagic stroke.

It is then determined if the patient should be given a medication called tPA — which needs to be administered within the first 3 hours after any signs of stroke began — to break up the blood clots. The team also determines if the patient requires treatment by neurology interventionists, who can retrieve a large blood clot using thin tubes inserted via the groin or the arm, a procedure called a thrombectomy.

Quality of care across the board

“Everything is planned,” Dr. Phillips says. “We have put together our own best practice protocol and saved minutes and minutes and minutes — sometimes upward of 15 to 20 minutes — in taking us to the patient, not the other way around. At every one of our hospitals we have the same protocols; the only thing that might differ is the geography of a hospital’s emergency department, and in some cases, patients are transferred to Sharp Grossmont’s Comprehensive Stroke Center for high-level specialty procedures.”

Such precision in timing means that someone experiencing a stroke can come into a Sharp ER, be diagnosed and treated, and begin their recovery within hours of their arrival. This is what happened when a woman in her early 40s recently arrived at the Sharp Grossmont ER.

“This patient arrived and she was dying,” Dr. Phillips says. “She was a stroke code. We scanned her and found a large basilar artery occlusion, which is very rare clot in the main brain artery. We treated her with tPA and removed the clot, and she was put onto the proper medications for recovery. Because of our protocol and everything going the way it should, she’s now at home with her family, walking, talking and helping take care of her grandkids.”

According to Dr. Phillips, people (like this patient) are getting very fast at recognizing stroke. Her experience is a good reminder of the importance of listening to our bodies for abnormal signals, especially on one side of the body, even if someone might consider themselves too young to have a stroke.

“Just because you’re 30 or 40, it doesn’t mean you’re not having a stroke. At any age, if you’re not able to function correctly, call 911.”

Sharp Grossmont Hospital is certified as a Comprehensive Stroke Center; Sharp Chula Vista Medical Center and Sharp Memorial Hospital are certified as Advanced Primary Stroke Centers; and Sharp Coronado Hospital is certified as an Acute Stroke Ready Hospital. All are certified by The Joint Commission, an independent, not-for-profit certification and accreditation organization. Learn more about Sharp stroke care.

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