Stroke Education and Recognition Programs Improve Care

The number of stroke patients brought to Atlantic Health's Overlook Hospital in Summit, New Jersey, nearly doubled from 492 in 2006 to 858 in 2009. And representatives at the hospital are elated about the news.

They attribute some of the growth in numbers to the success of stroke education and recognition programs they put in place to help EMS professionals identify stroke patients faster and more effectively, and ultimately give emergency departments the ability to better prepare for incoming stroke patients.

Laying the Groundwork

Overlook Hospital, as well as Morristown Memorial Hospital--which is also an Atlantic Health member hospital and the only accredited stroke trauma center in Morris County--began actively pursuing ways to improve stroke care after the American Heart Association announced its new guidelines related to stroke management in 2003, although the foundation had been laid with a New England Journal of Medicine study in 1995 that noted benefits associated with the administration of recombinant tissue plasminogen activator (rtPA) for acute ischemic stroke.

"Until the late 1990s, it was thought there wasn't much that could be done for stroke patients," says Dr. Shalini Bansil, medical director, Stroke Center, Atlantic Neuroscience Institute at Overlook Hospital, who also notes that stroke patients received basic care, but little was done in the way of more advanced medical treatment and surgical intervention done today. "Studies showed the efficacy of medication if given to stroke patients in a timely fashion. They also showed if patients who suffered a stroke are given care in an evidence-based fashion using certain guidelines and protocols in a stroke care facility, outcomes would be better."

Focus on EMS Professionals

Armed with that information, representatives at both hospitals introduced the first stroke education and recognition programs in 2005. While they have developed many community outreach programs directed at the public--including those presented at libraries, assisted living centers, etc.--a focus on EMS professionals is at the heart of the stroke awareness campaign.

"EMS professionals are vital to our success in the area of stroke care," says Stephanie Rizzo, stroke program coordinator, Morristown Memorial Hospital. "They are the first line of defense. When they are called to a location, they can assess the patient and notify us if they have a potential stroke patient. Our stroke team at the hospital can then be ready in the ED when the patient arrives. Rapid assessment and confirmation of symptoms can be completed, and determination about medical treatment or surgical interventions can quickly be made."

This rapid-response stroke initiative, spearheaded by Dr. Bansil--who was also instrumental in obtaining Overlook Hospital's designation as the first Comprehensive Stroke Center in New Jersey--is termed "Code Grey."

Created by an interdisciplinary team in collaboration with physicians, nurses and additional ER staff, Code Grey starts with EMS professionals in the field who are taught the F.A.S.T. approach to stroke symptom recognition, which is based on the Cincinnati Prehospital Stroke Scale. The scale tests for abnormal findings in the areas of facial paralysis (F), arm weakness (A) and speech difficulties (S) which can help identify if a patient is having a stroke. Time (T) is the final element. While the American Heart Association Stroke Council recently expanded the time window for rtPA treatment of acute ischemic stroke to 4.5 hours--up from 3 hours--knowing the time of onset of symptoms is still critical.

"We have found EMS professionals to very responsive to our stroke education and recognition programs," says Dr. Bansil. "They want to do the right thing for the patient. They want to learn what to do to provide the best care. And they are very excited to learn about new treatments. Most of them have heard bits and pieces about stroke care along the way, but we've put it all together for them so they have the information in once place."

New Program Components

Lecture-based programs with educational classes held at EMS squad houses, as well as at the respective hospitals, will continue to be offered next year. But new components are already being planned. Dr. Bansil relates that next year they hope to incorporate input from stroke survivors who are willing to talk about their experiences.

And Rizzo notes one new facet as already been well received. The first "Walk in Our Patients' Shoes" event was held November 16. This new element focuses on completing the circle of stroke care. "It's a collaborative effort between myself, the trauma coordinator and our cardiac nurse practitioners where we focus on providing information regarding our different specialties," explains Rizzo. "It culminates with a tour of the respective areas of the hospitals where patients are taken after EMS brings them in for initial treatment in the ED.

"We've had great feedback so far on this new program feature," she continues. "Stroke care is constantly changing. EMS professionals are fascinated with all the new information, such as the expansion of the rtPA treatment window and the surgical interventions we're able to do with acute ischemic stroke patients. And it's important that EMS staff continues to be involved. They are the first responders, and they're key advocates for people who may have experienced a stroke."